Healthcare Provider Details

I. General information

NPI: 1104181791
Provider Name (Legal Business Name): SHOSHONE PAIUTE TRIBES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1623 HOSPITAL LOOP ROAD
OWYHEE NV
89832-9800
US

IV. Provider business mailing address

PO BOX 130
OWYHEE NV
89832-0130
US

V. Phone/Fax

Practice location:
  • Phone: 775-757-2403
  • Fax:
Mailing address:
  • Phone: 775-757-2403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY MARSHALL
Title or Position: ADMINISTRATOR
Credential:
Phone: 775-757-2403