Provider Demographics
NPI:1316142623
Name:NEVADA FAMILY PRACTICE RESIDENCY PROGRAM, INC.
Entity type:Organization
Organization Name:NEVADA FAMILY PRACTICE RESIDENCY PROGRAM, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:PARCELLS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:702-968-5059
Mailing Address - Street 1:745 W MOANA LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4932
Mailing Address - Country:US
Mailing Address - Phone:775-334-3033
Mailing Address - Fax:775-334-3022
Practice Address - Street 1:745 W MOANA LN
Practice Address - Street 2:SUITE 100
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4932
Practice Address - Country:US
Practice Address - Phone:775-334-3033
Practice Address - Fax:775-334-3022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV005416100Medicaid