Basic Information
| Provider Information | |||||||||
| NPI: | 1417321902 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEVADA HEALTH CENTERS INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NEVADA HEALTH CENTERS AT VIRGINIA CITY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3325 RESEARCH WAY | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897067913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758886610 | ||||||||
| FaxNumber: | 7758884904 | ||||||||
| Practice Location | |||||||||
| Address1: | 175 E. CARSON STREET | ||||||||
| Address2: | SUITE A | ||||||||
| City: | VIRGINIA CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7754453510 | ||||||||
| FaxNumber: | 7758884990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2015 | ||||||||
| LastUpdateDate: | 03/04/2016 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | WALTER | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7758886610 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | 29D2103856 | NV | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 29D2103856 | 01 | NV | CLIA | OTHER |