Provider Demographics
NPI:1902287964
Name:RENOWN MEDICAL SCHOOL ASSOCIATES NORTH, INC.
Entity Type:Organization
Organization Name:RENOWN MEDICAL SCHOOL ASSOCIATES NORTH, INC.
Other - Org Name:SANFORD CENTER GERIATRIC CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO RENOWN HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-982-6488
Mailing Address - Street 1:1155 MILL ST # M14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:
Practice Address - Street 1:1664 N VIRGINIA ST
Practice Address - Street 2:CENTER FOR MOLECULAR MEDICINE, ROOM 150
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89557-0146
Practice Address - Country:US
Practice Address - Phone:775-982-1200
Practice Address - Fax:775-784-1814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV30470Medicare PIN