1700118536 NPI number — WASHOE BARTON MEDICAL CLINIC A NEVADA NONPROFIT CORPORATION

Table of content: (NPI 1700118536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700118536 NPI number — WASHOE BARTON MEDICAL CLINIC A NEVADA NONPROFIT CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WASHOE BARTON MEDICAL CLINIC A NEVADA NONPROFIT CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700118536
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1520 VIRGINIA RANCH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDNERVILLE
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89410-5731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-782-1550
Provider Business Mailing Address Fax Number:
775-782-1513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3919 CARTER DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLINGTON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-783-3096
Provider Business Practice Location Address Fax Number:
775-266-4074
Provider Enumeration Date:
02/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PRATER
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
775-782-1500

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  3986HOS-8 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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