Provider Demographics
NPI:1609129105
Name:WALKER RIVER PAIUTE TRIBE
Entity Type:Organization
Organization Name:WALKER RIVER PAIUTE TRIBE
Other - Org Name:WALKER RIVER TRIBAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCAULIFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-773-2005
Mailing Address - Street 1:P.O. BOX C
Mailing Address - Street 2:1025 HOSPITAL ROAD
Mailing Address - City:SCHURZ
Mailing Address - State:NV
Mailing Address - Zip Code:89427
Mailing Address - Country:US
Mailing Address - Phone:775-773-2005
Mailing Address - Fax:775-773-2009
Practice Address - Street 1:1025 HOSPITAL RD.
Practice Address - Street 2:
Practice Address - City:SCHURZ
Practice Address - State:NV
Practice Address - Zip Code:89427
Practice Address - Country:US
Practice Address - Phone:775-773-2005
Practice Address - Fax:775-773-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV28205AL-0291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory