NPIMap

Organization Active NPI

Medaisle Express, LLC

  • Family Medicine Physician
  • Reno, NV
National Provider Identifier
1194902916
Registry record updated Mar 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MEDAISLE EXPRESS, LLC
Practice address
6180 Mae Anne Ave
Suite 2
Reno, NV 89523-4700
Phone
(775) 284-5556
NPI assigned
Jan 23, 2008
Last updated
Mar 4, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Wesley Granstrom
Title
Owner
Phone
(775) 284-5556

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

6180 Mae Anne Ave
Suite 2
Reno, NV 89523-4700

Mailing address

6180 Mae Anne Ave
Suite 2
Reno, NV 89523-4700
Phone (775) 284-5556

National Provider Directory

National Provider Directory

Locations

6180 Mae Anne Ave
Ste 2
Reno, NV 89523
Phone (775) 284-5556

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204588800000",
    "number": "1194902916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6180 MAE ANNE AVE",
            "address_2": "SUITE 2",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895234700",
            "telephone_number": "775-284-5556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6180 MAE ANNE AVE",
            "address_2": "SUITE 2",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895234700",
            "telephone_number": "775-284-5556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDAISLE EXPRESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-23",
        "last_updated": "2008-03-04",
        "status": "A",
        "authorized_official_last_name": "GRANSTROM",
        "authorized_official_first_name": "WESLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "775-284-5556"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reno, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.