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General NPI Number Information
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NPI Number | 1245445071
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Entity Type | Organization
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Legal Business Name | DUCKWATER HEALTH CLINIC
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 502 DUCKWATER FALLS RD
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City | DUCKWATER
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State | NV
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Zip | 89314
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Country | US
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Telephone | 775-863-0222
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Fax |
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Provider Business Mailing Address
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Address Line | 502 DUCKWATER FALLS RD PO BOX 140087
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City | DUCKWATER
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State | NV
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Zip | 89314
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Country | US
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Telephone | 775-863-0222
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Fax |
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Authorized Official
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Title or Position | P.A.
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Name | MR. MARK WILBUR
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Credential | P.A.
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Telephone | 775-863-0222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332800000X
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Taxonomy Name | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
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License Number |
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License Number State |
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