Healthcare Provider Details

I. General information

NPI: 1588577274
Provider Name (Legal Business Name): KINROSS ROUND MOUNTAIN GOLD CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SMOKY VALLEY MINE ROAD
ROUND MOUNTAIN NV
89045
US

IV. Provider business mailing address

PO BOX 480
ROUND MOUNTAIN NV
89045-0480
US

V. Phone/Fax

Practice location:
  • Phone: 775-377-3267
  • Fax: 775-377-3368
Mailing address:
  • Phone: 775-377-3267
  • Fax: 775-377-3368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMBER NICOLE CLARK
Title or Position: CLINIC SUPERVISOR
Credential: RN
Phone: 775-377-3267