Provider Demographics
NPI:1346509064
Name:WASHOE ACCIDENT AND INJURY CENTER, INC
Entity type:Organization
Organization Name:WASHOE ACCIDENT AND INJURY CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:775-358-6824
Mailing Address - Street 1:1625 E PRATER WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-8969
Mailing Address - Country:US
Mailing Address - Phone:775-358-6824
Mailing Address - Fax:775-358-6843
Practice Address - Street 1:1625 E PRATER WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-8969
Practice Address - Country:US
Practice Address - Phone:775-358-6824
Practice Address - Fax:775-358-6843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00385261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service