Provider Demographics
NPI:1992919237
Name:SPARKS RADIOLOGY GROUP LTD.
Entity type:Organization
Organization Name:SPARKS RADIOLOGY GROUP LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-355-5021
Mailing Address - Street 1:PO BOX 21209
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89515-1209
Mailing Address - Country:US
Mailing Address - Phone:775-355-5021
Mailing Address - Fax:775-356-5590
Practice Address - Street 1:2375 E PRATER WAY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-9641
Practice Address - Country:US
Practice Address - Phone:775-356-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016811Medicaid
NV002016811Medicaid
NVE45464Medicare UPIN
NVWQBBH01Medicare ID - Type UnspecifiedMEDICARE