Provider Demographics
NPI:1558817213
Name:ADVANCED OTOLARYNGOLOGY ASSOCIATES
Entity type:Organization
Organization Name:ADVANCED OTOLARYNGOLOGY ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRCHFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-813-0186
Mailing Address - Street 1:10735 DOUBLE R BLVD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-8977
Mailing Address - Country:US
Mailing Address - Phone:775-852-3624
Mailing Address - Fax:775-852-3672
Practice Address - Street 1:10735 DOUBLE R BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-8977
Practice Address - Country:US
Practice Address - Phone:775-852-3624
Practice Address - Fax:775-852-3672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty