| Northern Nevada Medical Llc | |
|
801 E Williams Ave Fallon NV 89406-3052 | |
| (602) 821-4517 | |
| Not Available |
| Full Name | Northern Nevada Medical Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 801 E Williams Ave, Fallon, Nevada |
| Authorized Official Name and Position | Jeff Brouwer (OWNER) |
| Authorized Official Contact | 6028214517 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northern Nevada Medical Llc 801 E Williams Ave Fallon NV 89406-3052 Ph: () - | Northern Nevada Medical Llc 801 E Williams Ave Fallon NV 89406-3052 Ph: (602) 821-4517 |
| NPI Number | 1629767082 |
|---|---|
| Provider Enumeration Date | 05/02/2023 |
| Last Update Date | 07/06/2023 |
| Medicare PECOS PAC ID | 1153785902 |
|---|---|
| Medicare Enrollment ID | O20230912001773 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629767082 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Ramprasad C Dandillaya |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1316900236 PECOS PAC ID: 2062425556 Enrollment ID: I20150910002937 |
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