Provider Demographics
NPI:1386989465
Name:PYRAMID LAKE TRIBAL HEALTH CLINIC
Entity type:Organization
Organization Name:PYRAMID LAKE TRIBAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SICHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-574-1018
Mailing Address - Street 1:PO BOX 227
Mailing Address - Street 2:
Mailing Address - City:NIXON
Mailing Address - State:NV
Mailing Address - Zip Code:89424-0227
Mailing Address - Country:US
Mailing Address - Phone:775-574-1018
Mailing Address - Fax:775-574-1028
Practice Address - Street 1:7337 SANSOL DR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-6252
Practice Address - Country:US
Practice Address - Phone:775-303-3851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP0063261Q00000X
NVMI0170261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center