Basic Information
Provider Information | |||||||||
NPI: | 1851575641 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | NEVADA HEALTH CENTERS, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | CRESCENT VALLEY MEDICAL CLINIC | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1802 N CARSON ST STE 100 | ||||||||
Address2: |   | ||||||||
City: | CARSON CITY | ||||||||
State: | NV | ||||||||
PostalCode: | 897011227 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7758886610 | ||||||||
FaxNumber: | 7758877046 | ||||||||
Practice Location | |||||||||
Address1: | 5043 TENABO AVENUE | ||||||||
Address2: |   | ||||||||
City: | CRESCENT VALLEY | ||||||||
State: | NV | ||||||||
PostalCode: | 89821 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7754681010 | ||||||||
FaxNumber: | 7754681019 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/28/2007 | ||||||||
LastUpdateDate: | 12/28/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | INGREY | ||||||||
AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | PHARMACIST | ||||||||
AuthorizedOfficialTelephone: | 7758886610 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | RPH | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0002X | PH1212 | NV | Y |   | Suppliers | Pharmacy | Clinic Pharmacy |
No ID Information.