Provider Demographics
NPI:1508255019
Name:BATTLE MOUNTAIN GENERAL HOSPITAL
Entity Type:Organization
Organization Name:BATTLE MOUNTAIN GENERAL HOSPITAL
Other - Org Name:KINGSTON HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-635-2550
Mailing Address - Street 1:HC 65 BOX 102
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:NV
Mailing Address - Zip Code:89310-9105
Mailing Address - Country:US
Mailing Address - Phone:775-964-1232
Mailing Address - Fax:775-964-1238
Practice Address - Street 1:99 TOIYABE RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NV
Practice Address - Zip Code:89310
Practice Address - Country:US
Practice Address - Phone:775-964-1232
Practice Address - Fax:775-964-1238
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BATTLE MOUNTAIN GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-21
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20111774100261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV293987Medicare Oscar/Certification