Basic Information
| Provider Information | |||||||||
| NPI: | 1306435383 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HUMBOLDT GENERAL HOSPITAL CP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 118 E HASKELL ST | ||||||||
| Address2: | |||||||||
| City: | WINNEMUCCA | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894453299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7756235222 | ||||||||
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| Practice Location | |||||||||
| Address1: | 118 E HASKELL ST | ||||||||
| Address2: | |||||||||
| City: | WINNEMUCCA | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894453299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7756235222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2021 | ||||||||
| LastUpdateDate: | 01/13/2021 | ||||||||
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| AuthorizedOfficialLastName: | MANGRUM | ||||||||
| AuthorizedOfficialFirstName: | BONITA | ||||||||
| AuthorizedOfficialMiddleName: | DARLENE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF REVENUE | ||||||||
| AuthorizedOfficialTelephone: | 7756235222 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | BAA, BSN | ||||||||
| NPICertificationDate: | 01/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 282NC0060X | 01 | NV | TAXONOMY CODE | OTHER |