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General NPI Number Information
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NPI Number | 1699918243
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Entity Type | Organization
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Legal Business Name | WALKER RIVER PAIUTE TRIBAL CLINIC
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Dates
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Enumeration Date | 04/13/2009
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Last Update Date | 04/13/2009
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Provider Practice Location Address
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Address Line | PO BOX C PO BOX C
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City | SCHURZ
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State | NV
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Zip | 89427-0502
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Country | US
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Telephone | 775-773-2005
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Fax | 775-773-2012
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Provider Business Mailing Address
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Address Line | PO BOX C
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City | SCHURZ
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State | NV
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Zip | 89427-0502
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Country | US
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Telephone | 775-773-2005
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Fax | 775-773-2012
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | MR. KENNETH RICHARDSON
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Credential |
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Telephone | 775-773-2005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP0904X
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Taxonomy Name | Federal Public Health Clinic/Center
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License Number | 431
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License Number State | NV
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