Provider Demographics
NPI:1124098421
Name:RENOWN REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:RENOWN REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO ACUTE CARE
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-982-6343
Mailing Address - Street 1:1155 MILL ST
Mailing Address - Street 2:CENTRAL BUSINESS OFFICE N-12
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-6615
Mailing Address - Fax:775-982-8276
Practice Address - Street 1:1155 MILL STREET
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1474
Practice Address - Country:US
Practice Address - Phone:775-982-4100
Practice Address - Fax:775-982-4900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV669HOS-13282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA290001OtherBLUE CROSS
CAUSA291780OtherWMC CALIFORNIA BLUE SHLD
NVV100176OtherMEDICARE ROSTER BILLING
CAZZR20171FMedicaid
CAHSP60171FMedicaid
NV001216885Medicaid
NV001116885Medicaid
NVCC6040OtherBCBS
VW29000101OtherMEDICARE PART B
NVCC6040OtherBCBS
NV290001Medicare Oscar/Certification
290001Medicare PIN