Provider Demographics
NPI:1518937820
Name:RENOWN SOUTH MEADOWS MEDICAL CENTER
Entity type:Organization
Organization Name:RENOWN SOUTH MEADOWS MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO ACUTE CARE
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 1:1155 MILL ST # MCN-11
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:775-982-7000
Mailing Address - Fax:775-982-7089
Practice Address - Street 1:1495 MILL STREET
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1449
Practice Address - Country:US
Practice Address - Phone:775-982-3500
Practice Address - Fax:775-982-9009
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENOWN SOUTH MEADOWS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-26
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV657HOS-16273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCC7514OtherBLUE CROSS BLUE SHIELD
CAXHSP33672Medicaid
CAUSA291780OtherBLUE SHIELD OF CA
NV100502742Medicaid
CA29T049OtherBLUE CROSS OF CA
NV100502741Medicaid
NV5616006Medicaid
NV5616006Medicaid
NV100502742Medicaid