Provider Demographics
| NPI: | 1538424239 |
|---|---|
| Name: | SAINT MARYS MEDICAL GROUP INC. |
| Entity type: | Organization |
| Organization Name: | SAINT MARYS MEDICAL GROUP INC. |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | LEGAL COUNSEL |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | CHRISTOPHER |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | DOAN |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 310-259-4706 |
| Mailing Address - Street 1: | 411 W 6TH ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | RENO |
| Mailing Address - State: | NV |
| Mailing Address - Zip Code: | 89503-4415 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 775-770-7348 |
| Mailing Address - Fax: | 775-770-7368 |
| Practice Address - Street 1: | 411 W 6TH ST |
| Practice Address - Street 2: | |
| Practice Address - City: | RENO |
| Practice Address - State: | NV |
| Practice Address - Zip Code: | 89503-4415 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 775-770-7600 |
| Practice Address - Fax: | 775-770-7880 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2012-07-09 |
| Last Update Date: | 2019-02-14 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | |
| No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | Group - Multi-Specialty |
| No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207VM0101X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | Group - Multi-Specialty |
| No | 2080A0000X | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine | Group - Multi-Specialty |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
| No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty | |
| No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
| No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RC0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NV | HC224A | Medicare Oscar/Certification |
