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250 S. Main Street Box 347 Eureka NV 89316 | |
(775) 237-5313 | |
(775) 237-5073 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 250 S. Main Street, Eureka, Nevada |
Authorized Official Name and Position | Walter B Davis (CEO) |
Authorized Official Contact | 7758886610 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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3325 Research Way Carson City NV 89706-7913 Ph: (775) 888-6610 | 250 S. Main Street Box 347 Eureka NV 89316 Ph: (775) 237-5313 |
NPI Number | 1396823282 |
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Provider Enumeration Date | 11/01/2006 |
Last Update Date | 07/21/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1396823282 | NPI | - | NPPES |
1396823282 | Medicaid | NV | |
DQ468D | Other | NV | MEDICARE ID - TYPE UNSPECIFIED |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Nevada) | Primary |