Provider Demographics
NPI:1629168984
Name:STATE OF NEVADA
Entity Type:Organization
Organization Name:STATE OF NEVADA
Other - Org Name:RURAL CLINICS YERINGTON
Other - Org Type:Other Name
Authorized Official - Title/Position:AGENCY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:RICHARDSON-ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-486-4400
Mailing Address - Street 1:ATTN CYNDI SMITH
Mailing Address - Street 2:240 S. HUMAHUACA
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-2199
Mailing Address - Country:US
Mailing Address - Phone:775-751-7406
Mailing Address - Fax:775-751-7409
Practice Address - Street 1:215 W BRIDGE ST STE 5
Practice Address - Street 2:
Practice Address - City:YERINGTON
Practice Address - State:NV
Practice Address - Zip Code:89447-2544
Practice Address - Country:US
Practice Address - Phone:775-463-3191
Practice Address - Fax:775-463-4641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVVWQBGLMedicare PIN