=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154555019
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATKINSON, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2009
-----------------------------------------------------
Last Update Date | 05/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2281 AULTMAN ST
-----------------------------------------------------
City | ELY
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89301-1831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-296-1583
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1287
-----------------------------------------------------
City | MC GILL
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89318-1287
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-591-0307
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MR. OSKAR L ATKINSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 775-591-0307
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | PY0499
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------