Provider Demographics
NPI:1205098555
Name:NORTH VALLEY MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:NORTH VALLEY MEDICAL ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PAIVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-329-3434
Mailing Address - Street 1:10555 STEAD BLVD
Mailing Address - Street 2:STE 10
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-1871
Mailing Address - Country:US
Mailing Address - Phone:775-971-3300
Mailing Address - Fax:775-971-3307
Practice Address - Street 1:6542 S MCCARRAN BLVD
Practice Address - Street 2:STE B
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6142
Practice Address - Country:US
Practice Address - Phone:775-329-3434
Practice Address - Fax:775-329-5362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9005261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506378Medicaid