Provider Demographics
NPI:1457417198
Name:SIERRA ORTHOPEDICS
Entity type:Organization
Organization Name:SIERRA ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DORENE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ECKELHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-333-5555
Mailing Address - Street 1:645 N ARLINGTON AVE
Mailing Address - Street 2:SUITE 655
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4505
Mailing Address - Country:US
Mailing Address - Phone:775-333-5555
Mailing Address - Fax:775-333-5577
Practice Address - Street 1:645 N ARLINGTON AVE
Practice Address - Street 2:SUITE 655
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4505
Practice Address - Country:US
Practice Address - Phone:775-333-5555
Practice Address - Fax:775-333-5577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VWQBHYMedicare ID - Type Unspecified