Provider Demographics
NPI:1669490603
Name:PERSHING GENERAL HOSPITAL
Entity Type:Organization
Organization Name:PERSHING GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HIXENBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-273-2621
Mailing Address - Street 1:PO BOX 661
Mailing Address - Street 2:855 6TH STREET
Mailing Address - City:LOVELOCK
Mailing Address - State:NV
Mailing Address - Zip Code:89419-0661
Mailing Address - Country:US
Mailing Address - Phone:775-273-2621
Mailing Address - Fax:775-273-5183
Practice Address - Street 1:855 6TH ST.
Practice Address - Street 2:
Practice Address - City:LOVELOCK
Practice Address - State:NV
Practice Address - Zip Code:89419-0661
Practice Address - Country:US
Practice Address - Phone:775-273-2621
Practice Address - Fax:775-273-5183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV655HOS-11282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003414871Medicaid
NV291304Medicare Oscar/Certification
NV003414871Medicaid