County of Lander
Organization Active NPI Community Health Clinic/Center · Battle Mountain, NV
NPI 1447743703 · NPPES record last updated Oct 11, 2019
Key facts
- NPI
- 1447743703
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Health Clinic/Center 261QC1500X
- Legal business name
- COUNTY OF LANDER
- Practice address
- 825 N 2ND St
Battle Mountain, NV 89820-2834 - Phone
- (775) 635-2386
- NPI assigned
- Jun 12, 2018
- Organization subpart
- Yes
- Parent organization (as reported)
- COUNTY OF LANDER
Authorized official
- Name
- Deonilla Fuller
- Title
- Health Assistant
- Phone
- (775) 635-2386
Parent organization (reported in NPPES) 1
Other NPIs with the same Medicare PAC ID 1
Practitioners 5
-
Victor Keith Knutzen, MD, FACS, FACOG.
-
Troy Wayne Ross, MD
-
Mikel Ray Harris, PARAMEDIC
-
Robin Willcourt, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 29D2151496 | Lander County Community Health | Certificate of waiver | Jun 12, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NV
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220221001567 | NV | Part B Supplier - Clinic/Group Practice | 7012959356 |
Receives reassigned benefits from 2 practitioners Practice locations: Battle Mountain, NV |
National Provider Directory
- Part of
- Austin Ambulance SVC
Locations
825 N 2nd St
Battle Mountain, NV 89820
Phone (775) 635-2386
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Clinic/Center | 261QC1500X | Yes | ||
| Non-Surgical Family Planning Clinic/Center | 261QF0050X |
Addresses
Primary practice location
825 N 2ND St
Battle Mountain, NV 89820-2834
Mailing address
825 N 2ND St
Battle Mountain, NV 89820-2834
Phone (775) 635-2386
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700174802 | Medicaid | NV |
Other names
- Lander County Community Health
Other providers in Battle Mountain, NV
- Mary Catherine Bengoa
- David A Birnbaum
- Tina Marie Bisiaux
- Dana Blanc
- Abby Jessica Burkhart
- County of Lander
- DHHS IHS Phoenix Area
- Jennifer Douglas
- Lois M Erquiaga
- Mikel Ray Harris
All providers in Battle Mountain, NV · Community Health Clinic/Center in Nevada
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 11, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.