Organization
RUBY DOME ANESTHESIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES ROY COOPER CRNA (MEMBER)
(775) 778-6634
Entity
Organization
Contact information
Practice address
2001 ERRECART BLVD, NORTHEASTERN NEVADA REGIONAL HOSPITAL, ELKO, NV 89801
(775) 738-5151
Mailing address
PO BOX 2723, ELKO, NV 89803
(775) 778-6634
(775) 778-6634
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CH8833
MEDICARE PALMETTO GBA
NV
Enumeration date
11/07/2006
Last updated
08/22/2020
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