FT. MCDERMITT PAIUTE SHOSHONE TRIBE (NPI# 1316449291) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316449291 |
| Entity Type | Organization |
| Organization Name | FT. MCDERMITT PAIUTE SHOSHONE TRIBE |
| Other Organization Name | FT. MCDERMITT WELLNESS CENTER |
| Practice Address |
112 North Reservation Road Mcdermitt NV 89421-0315 |
| Mailing Address |
Po Box 315 Mc Dermitt NV 89421-0315 |
| Practice Telephone | 7755328522 |
| Practice Fax Number | 7755328024 |
| Mailing Telephone | 7755328522 |
| Mailing Fax Number | 7755328024 |
| Enumeration Date | 2018-03-06 |
| Last Update Date | 2020-09-05 |
| Authorized Official Name | DR. JACQUELINE J. BAE (EXECUTIVE DIRECTOR/HEALTH DIRECTOR) |
| Authorized Official Telephone | 7755322577 |
| Authorized Official Credential | MHA |
| Is Organization Subpart | Y |
| Parent Organization Name | FT. MCDERMITT PAUITE-SHOSHONE TRIBE |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QR1300X |
Clinic/Center Specialization: Rural Health |
APRN-002392 | NV | Ambulatory Health Care Facilities |
| N | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities | ||
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 1588710719 | 05 |
| Other Name | Type Code |
|---|---|
| Fort McDermitt Pauite-Shoshone Tribe | Other Name - Individual/Organization |
| Fort McDermitt Wellness Center | Doing Business As Name - Organization |
| Ft. McDermitt Wellness Center | Doing Business As Name - Organization |
| Street Address |
112 NORTH RESERVATION ROAD |
| City | MCDERMITT |
| State | NV |
| Zip Code | 89421-0315 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871634360 | Leora Rose Greenwood | Physician Assistant | 112 North Reservation Road, Mcdermitt, NV 89421-0055 | 2007-02-09 |
| 1518416577 | Public Health Service Ihs Mcdermitt Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 112 North Reservation Road, Mcdermitt, NV 89421 | 2016-09-30 |
| 1457610131 | Thelma Rose Simon | Counselor | 112 North Reservation Road, Fort Mcdermitt Indian Health Service, Mcdermitt, NV 89421 | 2012-05-15 |
| 1417233057 | Stacy Irene Rust | Registered Nurse | 112 North Reservation Road, Mcdermitt, NV 89421-0457 | 2011-10-27 |
| 1275820524 | Rodney Dale Burow | Physician Assistant | 112 North Reservation Road, Ihs Ft. Mcdermitt Clinic, Mcdermitt, NV 89421 | 2011-07-07 |
| 1194029322 | Phs Schurz Indian Health Service | Clinic/Center | 112 North Reservation Road, Mcdermitt, NV 89421 | 2011-01-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245627553 | Tracy Marshall | Licensed Practical Nurse | 112 N. Reservation Rd, Mcdermitt, NV 89421 | 2015-04-24 |
| 1043562101 | Brandon Joseph Grow | Emergency Medical Technician, Paramedic | 20 Olavarria, Ft. Mcdermitt E.m.s., Mcdermitt, NV 89421 | 2012-10-12 |
| 1871845958 | David Gerald Cameron | Emergency Medical Technician, Paramedic | 20 Olivarria, Ft. Mcdermitt Ems, Mcdermitt, NV 89421 | 2012-10-12 |
| 1386917011 | Wendy Jewel Dexter | Dietitian, Registered | 112 North Reservation Rd., Mcdermitt, NV 89421 | 2012-02-10 |
| 1285936351 | Usphs, Indian Health Service, Schurz | Ambulance | 20 Olivarria Street, Mcdermitt, NV 89421 | 2010-11-23 |
| 1235484262 | Merry Christine Trujillo | Emergency Medical Technician, Intermediate | 20 Olavarria Street, Mc Dermitt, NV 89421-0297 | 2012-07-16 |
| 1093069445 | Michael Dion Garfield | Emergency Medical Technician, Intermediate | 20 Olavarria, Mc Dermitt, NV 89421-0297 | 2012-11-07 |
| 1679012579 | Fort Mcdermitt Tribe | Counselor | 112 No Reservation Road, Mcdermitt, NV 89421-0315 | 2017-02-13 |
| 1801348024 | Fort Mcdermitt Wellness Center | Clinic/Center | 112 No Reservation Rd, Mcdermitt, NV 89421-0315 | 2016-11-04 |
| 1053394866 | Bettina Giselle Alvarez | Nurse Practitioner | 120 Cordero Road, Mcdermitt, NV 89421-0315 | 2005-11-25 |
| Find all providers in zip 89421 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801348024 | Fort Mcdermitt Wellness Center | Clinic/Center | 112 No Reservation Rd, Mcdermitt, NV 89421-0315 | 2016-11-04 |
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| 1588287544 | Advanced Practice House Calls LLC | Clinic/Center | 4647 Maxwell Peak Ct, Las Vegas, NV 89139-7648 | 2020-05-26 |
| 1023665676 | Vitality Restored Chiropractic and Wellness Center | Clinic/Center | 1742 W Horizon Ridge Pkwy Ste 110, Henderson, NV 89012-4833 | 2019-08-19 |
| 1891265997 | Elite Beg Limited Liability Co | Clinic/Center | 209 S Stephanie St # B177, Henderson, NV 89012-5501 | 2018-11-30 |
| 1659846699 | Jgbb LLC | Clinic/Center | 801 S Rancho Dr Ste D1-b, Las Vegas, NV 89106-3854 | 2018-10-05 |
| 1790272524 | Las Vegas Sleep Center ( Shamiya) Pllc | Clinic/Center | 2400 S Cimarron Rd, Suite 130, Las Vegas, NV 89117 | 2018-04-17 |
| 1750886784 | Aeva Clinic LLC | Clinic/Center | 4641 Blue Diamond Rd Ste 120a, Las Vegas, NV 89139-7610 | 2018-03-30 |
| 1275034621 | Faber IIi, Ltd. | Clinic/Center | 8811 W Sahara Ave Ste 200, Las Vegas, NV 89117-4813 | 2018-02-21 |
| 1033627120 | Aems | Clinic/Center | 197 Baker Street, Wells, NV 89835 | 2018-01-11 |
| 1710406467 | Anoush H. Tacvorian Do LLC | Clinic/Center | 6525 W. Warm Springs Rd, Suite 100, Las Vegas, NV 89118 | 2017-09-13 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.