Provider Demographics
NPI:1861757577
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:DEPUTY GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:RADHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVITALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-235-4308
Mailing Address - Street 1:645 N ARLINGTON AVE
Mailing Address - Street 2:SUITE 555
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4460
Mailing Address - Country:US
Mailing Address - Phone:775-770-7661
Mailing Address - Fax:
Practice Address - Street 1:5065 PYRAMID WAY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-7703
Practice Address - Country:US
Practice Address - Phone:775-770-7664
Practice Address - Fax:775-770-7358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center