Healthcare Provider Details

I. General information

NPI: 1265737084
Provider Name (Legal Business Name): WASHOE BARTON MEDICAL CLINIC A NEVADA NONPROFIT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1649 LUCERNE ST SUITE A & B
MINDEN NV
89423-4369
US

IV. Provider business mailing address

1520 VIRGINIA RANCH RD
GARDNERVILLE NV
89410-5731
US

V. Phone/Fax

Practice location:
  • Phone: 775-782-1603
  • Fax: 775-782-3417
Mailing address:
  • Phone: 775-783-3043
  • Fax: 775-782-1513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number3986HOS-8
License Number StateNV

VIII. Authorized Official

Name: MR. JEFFREY PRATER
Title or Position: CEO
Credential:
Phone: 775-782-1500