Provider Demographics
NPI:1720058027
Name:RENOWN SOUTH MEADOWS MEDICAL CENTER
Entity Type:Organization
Organization Name:RENOWN SOUTH MEADOWS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:T
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-982-6488
Mailing Address - Street 1:1155 MILL ST
Mailing Address - Street 2:CENTRAL BUSINESS OFFICE N-12
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-7000
Mailing Address - Fax:775-982-7089
Practice Address - Street 1:10101 DOUBLE R BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5931
Practice Address - Country:US
Practice Address - Phone:775-982-7000
Practice Address - Fax:775-982-7089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2373HOS-17282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502741Medicaid
CA290049OtherBLUE CROSS OF CA
NVCC7515OtherBCBS
V100380OtherMEDICARE PART B
CAXHSP43672Medicaid
NV100502742Medicaid
CAXHSP33672Medicaid
NVCC7515OtherBCBS
NV100502741Medicaid