Provider Demographics
NPI:1548217409
Name:ELY SHOSHONE TRIBE
Entity Type:Organization
Organization Name:ELY SHOSHONE TRIBE
Other - Org Name:NEWE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC SUPERVISOR/PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GARRET
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:GARBER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:775-289-2134
Mailing Address - Street 1:400 B NEWE VW
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:NV
Mailing Address - Zip Code:89301-3139
Mailing Address - Country:US
Mailing Address - Phone:775-289-2134
Mailing Address - Fax:775-289-4728
Practice Address - Street 1:400 NEWE VIEW
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:NV
Practice Address - Zip Code:89301
Practice Address - Country:US
Practice Address - Phone:775-289-4133
Practice Address - Fax:775-289-3237
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELY SHOSHONE TRIBE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-27
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7738261Q00000X
NV261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100509227Medicaid
NV100509226Medicaid
NVTR2030Medicare UPIN
NVTR2030Medicare PIN