| Organization Name: | NORTHERN NEVADA MEDICAL GROUP, LLC |
| NPI Number: | 1376891572 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN JOHANNESSON (VICE-PRESIDENT) |
| Mailing Address: | 2385 E Prater Way Suite 300 Sparks |
| State: | NV US |
| Postal Code: | 894349629 |
| Phone Number: | 7753564888 |
| Fax Number: | 7753564890 |
| NPI Enumeration Date: | 08/17/2012 |
| NPI Last Update Date: | 04/25/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |