Medallus Medical | |
1501 Lamoille Hwy Elko NV 89801-4321 | |
(775) 400-1510 | |
(775) 376-9578 |
Full Name | Medallus Medical |
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Speciality | Clinic/Center |
Location | 1501 Lamoille Hwy, Elko, Nevada |
Authorized Official Name and Position | Monique Aragon (COMPLIANCE ADMIN ASST/ CRED LIAISON) |
Authorized Official Contact | 8012601919 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Medallus Medical Po Box 95970 South Jordan UT 84095-0970 Ph: (800) 877-9236 | Medallus Medical 1501 Lamoille Hwy Elko NV 89801-4321 Ph: (775) 400-1510 |
NPI Number | 1902329469 |
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Provider Enumeration Date | 07/17/2017 |
Last Update Date | 07/17/2024 |
Medicare PECOS PAC ID | 3072871276 |
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Medicare Enrollment ID | O20171228001478 |
Identifier | Type | State | Issuer |
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1902329469 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Perry D Guthrie |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1477939882 PECOS PAC ID: 1254634850 Enrollment ID: I20160713002017 |
Provider Name | Sarah K Lino |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1407305618 PECOS PAC ID: 4284913443 Enrollment ID: I20161111000953 |
Provider Name | Rachot K Vacharothone |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1548228497 PECOS PAC ID: 9931013745 Enrollment ID: I20180420001526 |
Provider Name | Gabriel Bayi Ekortarh |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1922478890 PECOS PAC ID: 3476853250 Enrollment ID: I20190528001707 |
Provider Name | Josie Cervantes |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1619433307 PECOS PAC ID: 1557694718 Enrollment ID: I20190604001094 |
Provider Name | Melissa Ann Knox |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1780354092 PECOS PAC ID: 1355721382 Enrollment ID: I20220707002231 |
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