Healthcare Provider Details

I. General information

NPI: 1508077546
Provider Name (Legal Business Name): PRIME CARE NEVADA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 SOUTH MAIN STREET
TONOPAH NV
89049
US

IV. Provider business mailing address

P.O. BOX 391
TONOPAH NV
89049-0391
US

V. Phone/Fax

Practice location:
  • Phone: 775-482-6233
  • Fax: 775-482-8272
Mailing address:
  • Phone: 775-482-6233
  • Fax: 775-482-8272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK JOSEPH LATCHERAN
Title or Position: CEO
Credential:
Phone: 775-482-2460