Provider Demographics
NPI:1720144579
Name:HOGLE MILLER & WARD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:HOGLE MILLER & WARD PROFESSIONAL CORPORATION
Other - Org Name:THE ELKO CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:B
Authorized Official - Last Name:KIEHN
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:775-777-0215
Mailing Address - Street 1:1995 ERRECART BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-8336
Mailing Address - Country:US
Mailing Address - Phone:775-738-3111
Mailing Address - Fax:775-778-6728
Practice Address - Street 1:1995 ERRECART BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-8336
Practice Address - Country:US
Practice Address - Phone:775-738-3111
Practice Address - Fax:775-778-6728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV1822OtherBCBS
NVCN7767OtherRAILROAD MEDICARE
NVCN7767OtherRAILROAD MEDICARE