Provider Demographics
NPI:1417599184
Name:SILVER STATE HEALTH SERVICES
Entity Type:Organization
Organization Name:SILVER STATE HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-808-5739
Mailing Address - Street 1:2965 S JONES BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5606
Mailing Address - Country:US
Mailing Address - Phone:702-410-9195
Mailing Address - Fax:702-471-0421
Practice Address - Street 1:1430 E CALVADA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-5851
Practice Address - Country:US
Practice Address - Phone:702-410-9195
Practice Address - Fax:702-471-0421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-14
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)