MEDICARE: COUNTY OF LANDER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0050X	Non-Surgical Family Planning Clinic/Center
2	261QC1500X	Community Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447743703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF LANDER

Provider Business Mailing Address
First Line	:	825 N 2ND ST
Second Line	:
City	:	BATTLE MOUNTAIN
State	:	NV
Zip	:	89820-2834
Country	:	US
Telephone Number	:	775-635-2386
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 N 2ND ST
Second Line	:
City	:	BATTLE MOUNTAIN
State	:	NV
Zip	:	89820-2834
Country	:	US
Telephone Number	:	775-635-2386
Fax Number	:

Authorized Official
Title or Position	:	HEALTH ASSISTANT
Name	:	DEONILLA FULLER
Credential	:
Telephone Number	:	775-635-2386

Provider Enumeration Date	:	06/12/2018
Last Update Date	:	10/11/2019

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Directions to “COUNTY OF LANDER ” Practice Location

Language	Start Address	Practice Location

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