Provider Demographics
NPI:1922153519
Name:WASHOE BARTON MEDICAL CLINIC A NEVADA NONPROFIT CORPORATION
Entity Type:Organization
Organization Name:WASHOE BARTON MEDICAL CLINIC A NEVADA NONPROFIT CORPORATION
Other - Org Name:CARSON VALLEY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-782-1500
Mailing Address - Street 1:1107 HIGHWAY 395
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410
Mailing Address - Country:US
Mailing Address - Phone:775-782-1507
Mailing Address - Fax:775-783-4849
Practice Address - Street 1:1107 HIGHWAY 395
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410
Practice Address - Country:US
Practice Address - Phone:775-782-1507
Practice Address - Fax:775-783-4849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV102885Medicare PIN