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Organization
PROVIDER NETWORK, INC
Active
Organization
PROVIDER NETWORK, INC
Active
Parent organization
HOMETOWN HEALTH MANAGEMENT COMPANY
Other names
Fernley Medical Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
HOMETOWN HEALTH MANAGEMENT COMPANY
Authorized official
MR. BRETT MOORE (CFO ACUTE CARE)
(775) 982-6343
Entity
Organization
Contact information
Practice address
1343 NEWLANDS DR W, FERNLEY, NV 89408-8926
(775) 982-5000
(775) 982-6504
Mailing address
1155 MILL ST # M14, RENO, NV 89502-1576
(775) 982-5262
(775) 982-5496
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG0436
RR MEDICARE PTAN
NV
Enumeration date
05/23/2006
Last updated
06/07/2024
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