Provider Demographics
NPI:1023196292
Name:NEVADA HEALTH CENTERS INC
Entity Type:Organization
Organization Name:NEVADA HEALTH CENTERS INC
Other - Org Name:CRESCENT VALLEY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-888-6610
Mailing Address - Street 1:3325 RESEARCH WAY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-7913
Mailing Address - Country:US
Mailing Address - Phone:775-888-6610
Mailing Address - Fax:775-888-4904
Practice Address - Street 1:5043 TENABO AVENUE
Practice Address - Street 2:
Practice Address - City:CRESCENT VALLEY
Practice Address - State:NV
Practice Address - Zip Code:89821-1155
Practice Address - Country:US
Practice Address - Phone:775-468-1010
Practice Address - Fax:775-468-1019
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEVADA HEALTH CENTERS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDQ468DOtherMEDICARE ID - TYPE UNSPECIFIED
NV1023196292Medicaid
NV1023196292Medicaid