Healthcare Provider Details

I. General information

NPI: 1699284901
Provider Name (Legal Business Name): WILLIAM BEE RIRIE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 09/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5043 TENABO AVENUE WILLIAM BEE RIRIE HOSPITAL CRESCENT VALLEY CLINIC
CRESCENT VALLEY NV
89821
US

IV. Provider business mailing address

1500 AVENUE H
ELY NV
89301
US

V. Phone/Fax

Practice location:
  • Phone: 775-468-0250
  • Fax: 775-468-0255
Mailing address:
  • Phone: 775-289-3001
  • Fax: 775-289-6423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number8857
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8857
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8857
License Number StateNV

VIII. Authorized Official

Name: MR. MATTHEW F. WALKER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 775-289-3001