Healthcare Provider Details

I. General information

NPI: 1699918243
Provider Name (Legal Business Name): WALKER RIVER PAIUTE TRIBAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX C PO BOX C
SCHURZ NV
89427-0502
US

IV. Provider business mailing address

PO BOX C
SCHURZ NV
89427-0502
US

V. Phone/Fax

Practice location:
  • Phone: 775-773-2005
  • Fax: 775-773-2012
Mailing address:
  • Phone: 775-773-2005
  • Fax: 775-773-2012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number431
License Number StateNV

VIII. Authorized Official

Name: MR. KENNETH RICHARDSON
Title or Position: CLINIC DIRECTOR
Credential:
Phone: 775-773-2005