Healthcare Provider Details

I. General information

NPI: 1609129105
Provider Name (Legal Business Name): WALKER RIVER PAIUTE TRIBE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 HOSPITAL RD.
SCHURZ NV
89427
US

IV. Provider business mailing address

P.O. BOX C 1025 HOSPITAL ROAD
SCHURZ NV
89427
US

V. Phone/Fax

Practice location:
  • Phone: 775-773-2005
  • Fax: 775-773-2009
Mailing address:
  • Phone: 775-773-2005
  • Fax: 775-773-2009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number28205AL-0
License Number StateNV

VIII. Authorized Official

Name: ANDREW B MCAULIFFE
Title or Position: HEALTH DIRECTOR
Credential:
Phone: 775-773-2005