Provider Demographics
NPI:1184619025
Name:SIERRA NEVADA CARDIOLOGY ASSOCIATES CATHETERIZATION LABORATORY
Entity type:Organization
Organization Name:SIERRA NEVADA CARDIOLOGY ASSOCIATES CATHETERIZATION LABORATORY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-886-7889
Mailing Address - Street 1:75 PRINGLE WAY
Mailing Address - Street 2:G16
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1464
Mailing Address - Country:US
Mailing Address - Phone:775-327-8484
Mailing Address - Fax:775-327-8480
Practice Address - Street 1:75 PRINGLE WAY
Practice Address - Street 2:G16
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1464
Practice Address - Country:US
Practice Address - Phone:775-327-8484
Practice Address - Fax:775-327-8480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16043000012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV34900Medicare PIN