Provider Demographics
NPI:1508077546
Name:PRIME CARE NEVADA INC
Entity Type:Organization
Organization Name:PRIME CARE NEVADA INC
Other - Org Name:NYE REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LATCHERAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-482-2460
Mailing Address - Street 1:P.O. BOX 391
Mailing Address - Street 2:
Mailing Address - City:TONOPAH
Mailing Address - State:NV
Mailing Address - Zip Code:89049-0391
Mailing Address - Country:US
Mailing Address - Phone:775-482-6233
Mailing Address - Fax:775-482-8272
Practice Address - Street 1:825 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:TONOPAH
Practice Address - State:NV
Practice Address - Zip Code:89049
Practice Address - Country:US
Practice Address - Phone:775-482-6233
Practice Address - Fax:775-482-8272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100505391Medicaid
NV100505391Medicaid