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General NPI Number Information
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NPI Number | 1013304898
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Entity Type | Organization
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Legal Business Name | PRIMECARE NEVADA INC.
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Dates
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Enumeration Date | 04/20/2015
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Last Update Date | 04/20/2015
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Provider Practice Location Address
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Address Line | 825 S. MAIN STREET
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City | TONOPAH
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State | NV
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Zip | 89049-0391
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Country | US
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Telephone | 775-482-6233
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Fax | 775-482-6155
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Provider Business Mailing Address
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Address Line | 825 S. MAIN STREET
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City | TONOPAH
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State | NV
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Zip | 89049-0391
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Country | US
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Telephone | 775-482-6233
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Fax | 775-482-6155
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Authorized Official
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Title or Position | CE/ADMINISTRATOR
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Name | WAYNE C ALLEN
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Credential |
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Telephone | 775-482-6233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 65RUH-34
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License Number State | NV
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