Provider Demographics
NPI:1255367058
Name:PRIMECARE NEVADA DBA NYE REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:PRIMECARE NEVADA DBA NYE REGIONAL MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RESPONSIBLE OFFICER-PRESIDENT-ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEELIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-482-6237
Mailing Address - Street 1:P.O. BOX 391
Mailing Address - Street 2:825 S. MAIN STREET
Mailing Address - City:TONOPAH
Mailing Address - State:NV
Mailing Address - Zip Code:89049
Mailing Address - Country:US
Mailing Address - Phone:775-482-6233
Mailing Address - Fax:775-482-6155
Practice Address - Street 1:825 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:TONOPAH
Practice Address - State:NV
Practice Address - Zip Code:89049
Practice Address - Country:US
Practice Address - Phone:775-482-6233
Practice Address - Fax:775-482-8272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV001212869Medicaid
NV001112869Medicaid
NV001212869-0Medicaid
NV001912869Medicaid
NV001912869Medicaid
NV290020Medicare PIN