Provider Demographics
NPI:1477088722
Name:YERINGTON PAIUTE TRIBAL COUNCIL
Entity Type:Organization
Organization Name:YERINGTON PAIUTE TRIBAL COUNCIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name::LAURIRE
Authorized Official - Middle Name:A
Authorized Official - Last Name:THOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-463-3301
Mailing Address - Street 1:171 CAMPBELL LN
Mailing Address - Street 2:
Mailing Address - City:YERINGTON
Mailing Address - State:NV
Mailing Address - Zip Code:89447-9768
Mailing Address - Country:US
Mailing Address - Phone:775-783-0222
Mailing Address - Fax:775-463-5925
Practice Address - Street 1:171 CAMPBELL LN
Practice Address - Street 2:
Practice Address - City:YERINGTON
Practice Address - State:NV
Practice Address - Zip Code:89447-9768
Practice Address - Country:US
Practice Address - Phone:775-783-0222
Practice Address - Fax:775-463-5925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1750338646Medicaid