Provider Demographics
NPI:1861637415
Name:WASHOE TRIBE OF NEVADA AND CALIFORNIA
Entity Type:Organization
Organization Name:WASHOE TRIBE OF NEVADA AND CALIFORNIA
Other - Org Name:WASHOE TRIBE HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-265-4215
Mailing Address - Street 1:1559 WATASHEAMU RD
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89460-7455
Mailing Address - Country:US
Mailing Address - Phone:775-265-4215
Mailing Address - Fax:775-265-6071
Practice Address - Street 1:1559 WATASHEAMU RD
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89460-7455
Practice Address - Country:US
Practice Address - Phone:775-265-4215
Practice Address - Fax:775-265-6071
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHOE TRIBE OF NEVADA AND CALIFORNIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-11
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV5618420001Medicare NSC