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Organization
NORTHERN NEVADA MEDICAL GROUP, LLC
Active
Organization
NORTHERN NEVADA MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TODD EVANS (VP)
(610) 768-3300
Entity
Organization
Contact information
Practice address
2345 E PRATER WAY, SUITE 207, SPARKS, NV 89434-9600
(775) 352-5300
(775) 352-5334
Mailing address
2345 E PRATER WAY STE 207, SPARKS, NV 89434-9600
(775) 356-9393
(775) 356-5590
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RC0001X
Clinical Cardiac Electrophysiology Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
2084N0400X
Neurology Physician
—
—
208600000X
Surgery Physician
—
—
208M00000X
Hospitalist Physician
—
—
213E00000X
Podiatrist
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972751618
—
NV
01
—
DO8810
RR MEDICARE
NV
Enumeration date
09/06/2008
Last updated
08/17/2020
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