MEDICARE: NORTHERN NV URGENT CARE LP

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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1942498365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN NV URGENT CARE LP

Provider Business Mailing Address
First Line	:	PO BOX 660
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89702-0660
Country	:	US
Telephone Number	:	775-885-0919
Fax Number	:	775-885-0953

Provider Business Practice Location Address
First Line	:	2450 HWY 50 E
Second Line	:	SUITE 1
City	:	DAYTON
State	:	NV
Zip	:	89403-9402
Country	:	US
Telephone Number	:	775-246-9001
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. LEONARD HAMER
Credential	:
Telephone Number	:	775-885-2211

Provider Enumeration Date	:	10/10/2007
Last Update Date	:	11/05/2007

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