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311 Surprise Ave Yerington NV 89447-2565 | |
| (775) 463-2301 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 311 Surprise Ave, Yerington, Nevada |
| Authorized Official Name and Position | Kylee Fowler (MEDICAL STAFF COORDINATOR) |
| Authorized Official Contact | 7754636491 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
213 S Whitacre St Yerington NV 89447-2561 Ph: (775) 463-2301 | 311 Surprise Ave Yerington NV 89447-2565 Ph: (775) 463-2301 |
| NPI Number | 1992765085 |
|---|---|
| Provider Enumeration Date | 03/24/2006 |
| Last Update Date | 05/24/2023 |
| Medicare PECOS PAC ID | 0648178533 |
|---|---|
| Medicare Enrollment ID | O20100423000625 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992765085 | NPI | - | NPPES |
| 001510001 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 3381RHC-4 (Nevada) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |