NPIMap

Organization Active NPI

S Pannu Inc

  • Internal Medicine Physician
  • Susanville, CA
National Provider Identifier
1407987522
Registry record updated Jun 1, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
8682 Issued in NV
Legal business name
S PANNU INC
Practice address
1800 Spring Ridge Dr
Susanville, CA 96130-6100
Phone
(530) 252-2000
NPI assigned
Mar 8, 2007
Last updated
Jun 1, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2009

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

Authorized official

Name
Lori A Labrecque
Title
Accts. MGR
Phone
(702) 453-3799

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 8682 NV Primary

Addresses

Primary practice location

1800 Spring Ridge Dr
Susanville, CA 96130-6100

Mailing address

10624 S Eastern Ave
Suite 263
Henderson, NV 89052-2982
Phone (702) 597-1597

Other identifiers 2

IdentifierTypeStateIssuer
002018039MedicaidNV
A56442OtherCAMEDICAL LIC

National Provider Directory

National Provider Directory

Locations

10624 S Eastern Ave
#263
Henderson, NV 89052

10624 S Eastern Ave
Ste 263
Henderson, NV 89052

Practitioners & affiliated clinicians

Practitioners 56

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 56

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243814400000",
    "number": "1407987522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10624 S EASTERN AVE",
            "address_2": "SUITE 263",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890522982",
            "telephone_number": "702-597-1597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 SPRING RIDGE DR",
            "city": "SUSANVILLE",
            "state": "CA",
            "postal_code": "961306100",
            "telephone_number": "530-252-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "S PANNU INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2009-06-01",
        "status": "A",
        "authorized_official_last_name": "LABRECQUE",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ACCTS. MGR",
        "authorized_official_telephone_number": "702-453-3799"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "8682",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002018039",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LIC",
            "identifier": "A56442",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Susanville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2009; 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.