Provider Demographics
NPI:1790851616
Name:BATTLE MOUNTAIN GENERAL HOSPITAL
Entity Type:Organization
Organization Name:BATTLE MOUNTAIN GENERAL HOSPITAL
Other - Org Name:BATTLE MOUNTAIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-635-2550
Mailing Address - Street 1:535 S HUMBOLDT ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE MOUNTAIN
Mailing Address - State:NV
Mailing Address - Zip Code:89820-1988
Mailing Address - Country:US
Mailing Address - Phone:775-635-2550
Mailing Address - Fax:775-635-8844
Practice Address - Street 1:535 S HUMBOLDT ST STE A
Practice Address - Street 2:
Practice Address - City:BATTLE MOUNTAIN
Practice Address - State:NV
Practice Address - Zip Code:89820-1988
Practice Address - Country:US
Practice Address - Phone:775-635-2550
Practice Address - Fax:775-635-8844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4872RHC-5261QR1300X
NV631HOS-14282NC0060X
NV4213EXL-0291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100510688Medicaid
NV002008400Medicaid
NV100505167Medicaid
NVVB29001301Medicare PIN
NV100505167Medicaid
NV293984Medicare Oscar/Certification
NV002008400Medicaid
NV293984Medicare Oscar/Certification