Provider Demographics
NPI:1023345071
Name:JOHN R. LEMIEUX MD LTD
Entity type:Organization
Organization Name:JOHN R. LEMIEUX MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEMIEUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-323-5116
Mailing Address - Street 1:6630 S. MCCORRAN BLVD.
Mailing Address - Street 2:BUILDING B SUITE 16
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6145
Mailing Address - Country:US
Mailing Address - Phone:775-323-5116
Mailing Address - Fax:775-323-7140
Practice Address - Street 1:6630 S. MCCORRAN BLVD
Practice Address - Street 2:BUILDING B SUITE 16
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6145
Practice Address - Country:US
Practice Address - Phone:775-323-5116
Practice Address - Fax:775-323-7140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3602207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016151Medicaid
NV002016151Medicaid
V942148201Medicare PIN