Provider Demographics
NPI:1750498010
Name:HUMBOLDT GENERAL HOSPITAL
Entity Type:Organization
Organization Name:HUMBOLDT GENERAL HOSPITAL
Other - Org Name:HUMBOLDT COUNTY HOSPITAL DISTRICT
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCKHORST
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:775-623-5222
Mailing Address - Street 1:118 E HASKELL ST
Mailing Address - Street 2:
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89445-3247
Mailing Address - Country:US
Mailing Address - Phone:775-623-5222
Mailing Address - Fax:775-623-5904
Practice Address - Street 1:118 E HASKELL ST
Practice Address - Street 2:
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-3247
Practice Address - Country:US
Practice Address - Phone:775-623-5222
Practice Address - Fax:775-623-5904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV645HOS-11282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV001207855Medicaid
NV100510385Medicaid