Provider Demographics
NPI:1356421655
Name:SIERRA PODIATRY CENTER, LLP
Entity type:Organization
Organization Name:SIERRA PODIATRY CENTER, LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:K
Authorized Official - Last Name:BEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:775-882-1441
Mailing Address - Street 1:1801 N CARSON ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-1216
Mailing Address - Country:US
Mailing Address - Phone:775-882-1441
Mailing Address - Fax:
Practice Address - Street 1:1801 N CARSON ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-1216
Practice Address - Country:US
Practice Address - Phone:775-882-1441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0101213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNA 674338Medicaid
NVU90434Medicare UPIN
NV36484Medicare PIN
NV6207310001Medicare NSC