Basic Information
| Provider Information | |||||||||
| NPI: | 1649398512 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEVADA HEALTH CENTERS, INC. | ||||||||
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| OtherOrganizationName: | NEVADA HEALTH CENTERS OB-GYN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1802 N CARSON ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897011215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758886610 | ||||||||
| FaxNumber: | 7758877046 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 SHADOW LN | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891064363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022537802 | ||||||||
| FaxNumber: | 7026336474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 10/07/2010 | ||||||||
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| AuthorizedOfficialLastName: | CHASE | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7758871590 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NEVADA HEALTH CENTERS, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | NV | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 100508012 | 05 | NV | MEDICAID |