Provider Demographics
NPI:1871972661
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:DAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-574-1018
Mailing Address - Street 1:8175 S VIRGINIA ST
Mailing Address - Street 2:#850-284
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-8922
Mailing Address - Country:US
Mailing Address - Phone:775-209-3996
Mailing Address - Fax:
Practice Address - Street 1:705 HIGHWAY 446
Practice Address - Street 2:
Practice Address - City:NIXON
Practice Address - State:NV
Practice Address - Zip Code:89424
Practice Address - Country:US
Practice Address - Phone:775-574-1018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN44243261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health