Provider Demographics
NPI:1730408949
Name:NORTHEASTERN NEVADA PHYSICIAN PRACTICES LLC
Entity type:Organization
Organization Name:NORTHEASTERN NEVADA PHYSICIAN PRACTICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-920-7000
Mailing Address - Street 1:1995 ERRECART BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-8346
Mailing Address - Country:US
Mailing Address - Phone:775-777-2061
Mailing Address - Fax:775-777-2067
Practice Address - Street 1:1995 ERRECART BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-8346
Practice Address - Country:US
Practice Address - Phone:775-777-2061
Practice Address - Fax:775-777-2067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty