Provider Demographics
NPI:1043499130
Name:PIONEER URGENT AND FAMILY MEDICAL CLINIC
Entity type:Organization
Organization Name:PIONEER URGENT AND FAMILY MEDICAL CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGERON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-738-2034
Mailing Address - Street 1:PO BOX 2710
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89803-2710
Mailing Address - Country:US
Mailing Address - Phone:775-738-2034
Mailing Address - Fax:775-738-3241
Practice Address - Street 1:160 12TH ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-4002
Practice Address - Country:US
Practice Address - Phone:775-738-2034
Practice Address - Fax:775-738-3241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV705372261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E69664Medicare PIN
WMBQS02Medicare PIN