Provider Demographics
NPI:1558633131
Name:PRIMECARE NEVADA INC.
Entity Type:Organization
Organization Name:PRIMECARE NEVADA INC.
Other - Org Name:NYE REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICER
Authorized Official - Phone:775-482-2461
Mailing Address - Street 1:PO 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 1:301 S. 2ND ST.
Practice Address - Street 2:
Practice Address - City:BEATTY
Practice Address - State:NV
Practice Address - Zip Code:89003
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:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty