Healthcare Provider Details

I. General information

NPI: 1780961102
Provider Name (Legal Business Name): DHHS IHS PHOENIX AREA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 SHOSHONE CIR
ELKO NV
89801-5072
US

IV. Provider business mailing address

515 SHOSHONE CIR
ELKO NV
89801-5072
US

V. Phone/Fax

Practice location:
  • Phone: 775-738-2252
  • Fax: 775-748-1455
Mailing address:
  • Phone: 775-738-2252
  • Fax: 775-748-1455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CATHY E WELCHERT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 775-738-2252