=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063611879
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WHITE PINE COUNTY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2007
-----------------------------------------------------
Last Update Date | 07/12/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 995 CAMPTON ST SUITE 2
-----------------------------------------------------
City | ELY
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89301-1987
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-289-3271
-----------------------------------------------------
Fax | 775-289-2405
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 995 CAMPTON ST SUITE 2
-----------------------------------------------------
City | ELY
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89301-1987
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-289-3271
-----------------------------------------------------
Fax | 775-289-2405
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FINANCE DIRECTOR
-----------------------------------------------------
Name | MS. ELIZABETH FRANCIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 775-289-1591
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 17392
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 17357
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 17358
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 17359
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 17127
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------