Healthcare Provider Details

I. General information

NPI: 1245445071
Provider Name (Legal Business Name): DUCKWATER HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 DUCKWATER FALLS RD
DUCKWATER NV
89314
US

IV. Provider business mailing address

502 DUCKWATER FALLS RD PO BOX 140087
DUCKWATER NV
89314
US

V. Phone/Fax

Practice location:
  • Phone: 775-863-0222
  • Fax:
Mailing address:
  • Phone: 775-863-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK WILBUR
Title or Position: P.A.
Credential: P.A.
Phone: 775-863-0222