Jackpot Community Health Center | |
950 Lady Luck Drive Box 628 Jackpot NV 89825-0628 | |
(775) 755-2500 | |
(775) 755-2502 |
Full Name | Jackpot Community Health Center |
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Speciality | Clinic/Center |
Location | 950 Lady Luck Drive, Jackpot, Nevada |
Authorized Official Name and Position | Walter B Davis (CEO) |
Authorized Official Contact | 7758886610 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Jackpot Community Health Center 3325 Research Way Carson City NV 89706-7913 Ph: (775) 888-6610 | Jackpot Community Health Center 950 Lady Luck Drive Box 628 Jackpot NV 89825-0628 Ph: (775) 755-2500 |
NPI Number | 1497833768 |
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Provider Enumeration Date | 11/02/2006 |
Last Update Date | 07/21/2022 |
Medicare PECOS PAC ID | 7113835307 |
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Medicare Enrollment ID | O20100730000166 |
Identifier | Type | State | Issuer |
---|---|---|---|
1497833768 | NPI | - | NPPES |
DQ468C | Other | NV | MEDICARE ID - TYPE UNSPECIFIED |
1497833768 | Medicaid | NV |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Nevada) | Primary |