Provider Demographics
NPI:1871182683
Name:FORT MCDERMITT PAIUTE SHOSHONE TRIBE
Entity type:Organization
Organization Name:FORT MCDERMITT PAIUTE SHOSHONE TRIBE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:FERGUS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LAUGHRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-250-8665
Mailing Address - Street 1:PO BOX 315
Mailing Address - Street 2:
Mailing Address - City:FT MCDERMITT
Mailing Address - State:NV
Mailing Address - Zip Code:89421-0315
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:112 N RESERVATION RD
Practice Address - Street 2:
Practice Address - City:FT MCDERMITT
Practice Address - State:NV
Practice Address - Zip Code:89421-9804
Practice Address - Country:US
Practice Address - Phone:775-532-8522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport