Provider Demographics
NPI:1205088838
Name:GERIATRIC SPECIALTY CARE OF NEVADA, PLLC, STEVEN L. PHILLIPS, M.D.
Entity type:Organization
Organization Name:GERIATRIC SPECIALTY CARE OF NEVADA, PLLC, STEVEN L. PHILLIPS, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANZEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-401-8820
Mailing Address - Street 1:PO BOX 511360
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-7915
Mailing Address - Country:US
Mailing Address - Phone:775-398-1981
Mailing Address - Fax:775-398-1984
Practice Address - Street 1:6880 S MCCARRAN BLVD STE 5
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6129
Practice Address - Country:US
Practice Address - Phone:775-398-1981
Practice Address - Fax:775-398-1984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9713207RG0300X
NV6596207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1205088838Medicaid