Healthcare Provider Details

I. General information

NPI: 1316314065
Provider Name (Legal Business Name): BEATTY MEDICAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S. IRVING ST
BEATTY NV
89003-0250
US

IV. Provider business mailing address

PO BOX 250
BEATTY NV
89003-0250
US

V. Phone/Fax

Practice location:
  • Phone: 775-553-9111
  • Fax:
Mailing address:
  • Phone: 775-553-9111
  • Fax: 775-553-9200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10499
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number3457
License Number StateNV

VIII. Authorized Official

Name: DR. ROBERT WEBB
Title or Position: OWNER
Credential: MD
Phone: 775-553-9111