Provider Demographics
NPI:1417309295
Name:SPRING MOUNTAIN HEALTHCARE LLC
Entity Type:Organization
Organization Name:SPRING MOUNTAIN HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:775-727-8900
Mailing Address - Street 1:2250 POSTAL DR STE 4
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-4798
Mailing Address - Country:US
Mailing Address - Phone:775-727-8900
Mailing Address - Fax:775-727-8452
Practice Address - Street 1:2250 POSTAL DR STE 4
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-4798
Practice Address - Country:US
Practice Address - Phone:775-727-8900
Practice Address - Fax:775-727-8452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8408261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service