Provider Demographics
NPI:1063891182
Name:NEVADA HEALTH CENTERS INC
Entity type:Organization
Organization Name:NEVADA HEALTH CENTERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-888-6610
Mailing Address - Street 1:3325 RESEARCH WAY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-7913
Mailing Address - Country:US
Mailing Address - Phone:775-888-6610
Mailing Address - Fax:775-888-4904
Practice Address - Street 1:98 E LAKE MEAD PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-5540
Practice Address - Country:US
Practice Address - Phone:702-868-0327
Practice Address - Fax:702-868-0290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-21
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVH80-015005261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1063891182Medicaid
NVDQ468AMedicare PIN
NV1063891182Medicaid