MEDICARE: COUNTY OF NEVADA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2400X	Prison Health Clinic/Center

General Provider Information

NPI Number	:	1790542306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF NEVADA

Provider Business Mailing Address
First Line	:	950 MAIDU AVE
Second Line	:
City	:	NEVADA CITY
State	:	CA
Zip	:	95959-8600
Country	:	US
Telephone Number	:	530-265-1471
Fax Number	:	530-470-0439

Provider Business Practice Location Address
First Line	:	925 MAIDU AVE
Second Line	:
City	:	NEVADA CITY
State	:	CA
Zip	:	95959-8600
Country	:	US
Telephone Number	:	530-265-1471
Fax Number	:

Authorized Official
Title or Position	:	LIEUTENANT
Name	:	MRS. JENNIFER MARIE MCCORMACK
Credential	:
Telephone Number	:	530-470-2616

Provider Enumeration Date	:	02/29/2024
Last Update Date	:	12/03/2025

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Directions to “COUNTY OF NEVADA ” Practice Location

Language	Start Address	Practice Location

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