Provider Demographics
NPI:1376882217
Name:WINNEMUCCA FAMILY MEDICINE CLINIC, LTD.
Entity Type:Organization
Organization Name:WINNEMUCCA FAMILY MEDICINE CLINIC, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-304-7918
Mailing Address - Street 1:PO BOX 2638
Mailing Address - Street 2:
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89446-2638
Mailing Address - Country:US
Mailing Address - Phone:775-304-7918
Mailing Address - Fax:775-623-4662
Practice Address - Street 1:1038 GRASS VALLEY RD
Practice Address - Street 2:SUITE I
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-4207
Practice Address - Country:US
Practice Address - Phone:775-621-5270
Practice Address - Fax:775-621-5265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20121768234261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVH94592Medicare UPIN