Basic Information
| Provider Information | |||||||||
| NPI: | 1174708879 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARSON VALLEY MEDICAL CENTER RURAL HEALTH CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1520 VIRGINIA RANCH ROAD | ||||||||
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| City: | GARDNERVILLE | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894105731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757821550 | ||||||||
| FaxNumber: | 7757821513 | ||||||||
| Practice Location | |||||||||
| Address1: | 1520 VIRGINIA RANCH RD | ||||||||
| Address2: | |||||||||
| City: | GARDNERVILLE | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894105731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757821550 | ||||||||
| FaxNumber: | 7757821513 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/01/2008 | ||||||||
| LastUpdateDate: | 12/02/2019 | ||||||||
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| AuthorizedOfficialLastName: | PRATER | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7757821500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.