Provider Demographics
NPI:1770998510
Name:RENOWN REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:RENOWN REGIONAL MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-982-6343
Mailing Address - Street 1:10315 PROFESSIONAL CIR STE 101
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-4803
Mailing Address - Country:US
Mailing Address - Phone:775-982-2828
Mailing Address - Fax:
Practice Address - Street 1:10315 PROFESSIONAL CIR STE 101
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-4803
Practice Address - Country:US
Practice Address - Phone:775-982-2828
Practice Address - Fax:775-982-2834
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENOWN REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-30
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207QH0002X, 207RH0002X
NV251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community Based
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV291542Medicare Oscar/Certification