Provider Demographics
NPI:1700118536
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:TOPAZ RANCH MEDICAL CLINIC
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 1:1520 VIRGINIA RANCH RD
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-5731
Mailing Address - Country:US
Mailing Address - Phone:775-782-1550
Mailing Address - Fax:775-782-1513
Practice Address - Street 1:3919 CARTER DRIVE
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:NV
Practice Address - Zip Code:89444
Practice Address - Country:US
Practice Address - Phone:775-783-3096
Practice Address - Fax:775-266-4074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3986HOS-8261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV105788Medicare PIN
NV293985Medicare PIN
NV293985Medicare Oscar/Certification
NVV105703Medicare PIN