Basic Information
| Provider Information | |||||||||
| NPI: | 1699284901 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILLIAM BEE RIRIE HOSPITAL | ||||||||
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| OtherOrganizationName: | WILLIAM BEE RIRIE HOSPITAL CRESCENT VALLEY CLINIC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 AVENUE H | ||||||||
| Address2: | |||||||||
| City: | ELY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7752893001 | ||||||||
| FaxNumber: | 7752896423 | ||||||||
| Practice Location | |||||||||
| Address1: | 5043 TENABO AVENUE | ||||||||
| Address2: | WILLIAM BEE RIRIE HOSPITAL CRESCENT VALLEY CLINIC | ||||||||
| City: | CRESCENT VALLEY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7754680250 | ||||||||
| FaxNumber: | 7754680255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2017 | ||||||||
| LastUpdateDate: | 09/29/2017 | ||||||||
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| AuthorizedOfficialLastName: | WALKER | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | F. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7752893001 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WILLIAM BEE RIRIE HOSPITAL | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 8857 | NV | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 363AM0700X | 8857 | NV | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363LF0000X | 8857 | NV | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.