Provider Demographics
NPI:1972901320
Name:THE NEVADA CENTER
Entity type:Organization
Organization Name:THE NEVADA CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SHALLENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-884-3990
Mailing Address - Street 1:1231 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-8372
Mailing Address - Country:US
Mailing Address - Phone:775-884-3990
Mailing Address - Fax:775-884-2202
Practice Address - Street 1:1231 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-8372
Practice Address - Country:US
Practice Address - Phone:775-884-3990
Practice Address - Fax:775-884-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4951207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1346300035OtherNONE