Provider Demographics
NPI:1407493141
Name:MT GRANT GENERAL HOSPITAL
Entity Type:Organization
Organization Name:MT GRANT GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOSPITAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:
Authorized Official - Last Name:QUALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-945-2461
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NV
Mailing Address - Zip Code:89415-1510
Mailing Address - Country:US
Mailing Address - Phone:775-945-2461
Mailing Address - Fax:775-945-2359
Practice Address - Street 1:200 SOUTH A STREET
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NV
Practice Address - Zip Code:89415-1510
Practice Address - Country:US
Practice Address - Phone:775-945-2461
Practice Address - Fax:775-945-2359
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MT GRANT GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, IntermediateGroup - Single Specialty