Wildcreek Family Medical Center

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WILDCREEK FAMILY MEDICAL CENTER

Practice address

2125 Green Vista Dr
Suite 106
Sparks, NV 89431-8545

Phone

(775) 673-6681

Fax

(775) 673-6682

NPI assigned

Mar 6, 2007

Organization subpart

No

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

Authorized official

Name

Phillis Maxine Boyd, DO

Title

Owner

Phone

(775) 673-6681

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354752000000",
    "number": "1619007176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2125 GREEN VISTA DR",
            "address_2": "SUITE 106",
            "city": "SPARKS",
            "state": "NV",
            "postal_code": "894318545",
            "telephone_number": "775-673-6681",
            "fax_number": "775-673-6682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2125 GREEN VISTA DR",
            "address_2": "SUITE 106",
            "city": "SPARKS",
            "state": "NV",
            "postal_code": "894318545",
            "telephone_number": "775-673-6681",
            "fax_number": "775-673-6682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDCREEK FAMILY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2012-12-06",
        "status": "A",
        "authorized_official_last_name": "BOYD",
        "authorized_official_first_name": "PHILLIS",
        "authorized_official_middle_name": "MAXINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "775-673-6681",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMEDICARE",
            "identifier": "DB9089",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002016380",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kailey White, CCC-SLP
• Wendy White
• Lujean Whitmore
• Kelly Maureen Whyte, MFT INTERN
• Kristen Summer Wilcox
• Wildcreek Physical Therapy, Inc.
• Wildcreek Surgery Center
• Rachel Wilde, DPT
• Molly Marie Wilder, APRN
• Bryan D Wildman, MA

• Family Medicine Physician in Sparks, NV
• Providers in Sparks, NV by specialty
• Family Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2012; 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.