| Ft. Mcdermitt Wellness Center | |
|
112 North Reservation Rd Mcdermitt NV 89421-0315 | |
| (775) 532-8522 | |
| (775) 532-8024 |
| Full Name | Ft. Mcdermitt Wellness Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 112 North Reservation Rd, Mcdermitt, Nevada |
| Authorized Official Name and Position | Fergus John Laughridge (HEALTH DIRECTOR) |
| Authorized Official Contact | 7755328522 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ft. Mcdermitt Wellness Center P.o Box 315 Mcdermitt NV 89421-0315 Ph: (775) 532-8522 | Ft. Mcdermitt Wellness Center 112 North Reservation Rd Mcdermitt NV 89421-0315 Ph: (775) 532-8522 |
| NPI Number | 1316449291 |
|---|---|
| Provider Enumeration Date | 03/06/2018 |
| Last Update Date | 08/30/2022 |
| Medicare PECOS PAC ID | 6608206537 |
|---|---|
| Medicare Enrollment ID | O20200416003984 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316449291 | NPI | - | NPPES |
| 1588710719 | Medicaid | CA | |
| 100561450 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Pamela Vanessa Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770564189 PECOS PAC ID: 2264453976 Enrollment ID: I20221111001012 |
Fort Mcdermitt Wellness Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 112 No Reservation Rd, Mcdermitt, NV 89421 Phone: 775-532-8522 Fax: 775-532-8024 |