Provider Demographics
NPI:1134449739
Name:HIGH DESERT SPORTS MEDICINE AND REHABILITATION LLC
Entity type:Organization
Organization Name:HIGH DESERT SPORTS MEDICINE AND REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:B
Authorized Official - Last Name:WHALEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-482-2473
Mailing Address - Street 1:PO BOX 1667
Mailing Address - Street 2:
Mailing Address - City:TONOPAH
Mailing Address - State:NV
Mailing Address - Zip Code:89049-1667
Mailing Address - Country:US
Mailing Address - Phone:775-482-2473
Mailing Address - Fax:
Practice Address - Street 1:HWY 376
Practice Address - Street 2:
Practice Address - City:CARVERS
Practice Address - State:NV
Practice Address - Zip Code:89045
Practice Address - Country:US
Practice Address - Phone:775-482-2473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20101384700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty