Provider Demographics
NPI:1750338646
Name:YERINGTON PAIUTE TRIBAL COUNCIL
Entity type:Organization
Organization Name:YERINGTON PAIUTE TRIBAL COUNCIL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-463-3335
Mailing Address - Street 1:171 CAMPBELL LN
Mailing Address - Street 2:
Mailing Address - City:YERINGTON
Mailing Address - State:NV
Mailing Address - Zip Code:89447-9731
Mailing Address - Country:US
Mailing Address - Phone:775-463-3335
Mailing Address - Fax:775-463-5925
Practice Address - Street 1:171 CAMPBELL LN
Practice Address - Street 2:
Practice Address - City:YERINGTON
Practice Address - State:NV
Practice Address - Zip Code:89447-9731
Practice Address - Country:US
Practice Address - Phone:775-463-3335
Practice Address - Fax:775-463-5925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV004710002Medicaid
NV100500254Medicaid
NV003110002Medicaid
NV100502779Medicaid