Provider Demographics
NPI:1245445071
Name:DUCKWATER HEALTH CLINIC
Entity type:Organization
Organization Name:DUCKWATER HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P.A.
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WILBUR
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:775-863-0222
Mailing Address - Street 1:502 DUCKWATER FALLS RD
Mailing Address - Street 2:PO BOX 140087
Mailing Address - City:DUCKWATER
Mailing Address - State:NV
Mailing Address - Zip Code:89314
Mailing Address - Country:US
Mailing Address - Phone:775-863-0222
Mailing Address - Fax:
Practice Address - Street 1:502 DUCKWATER FALLS RD
Practice Address - Street 2:
Practice Address - City:DUCKWATER
Practice Address - State:NV
Practice Address - Zip Code:89314
Practice Address - Country:US
Practice Address - Phone:775-863-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
No332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2907369OtherASEP NCPDP NUMBER
1144222761OtherCLINIC NPI NUMBER