| Medallus Medical | |
|
1501 Lamoille Hwy Elko NV 89801-4321 | |
| (775) 400-1510 | |
| (775) 984-5170 |
| Full Name | Medallus Medical |
|---|---|
| Speciality | Clinic/Center |
| Location | 1501 Lamoille Hwy, Elko, Nevada |
| Authorized Official Name and Position | Rachot K Vacharothone (CEO) |
| Authorized Official Contact | 8015010500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medallus Medical Po Box 95970 South Jordan UT 84095-0970 Ph: (800) 877-9236 | Medallus Medical 1501 Lamoille Hwy Elko NV 89801-4321 Ph: (775) 400-1510 |
| NPI Number | 1902329469 |
|---|---|
| Provider Enumeration Date | 07/17/2017 |
| Last Update Date | 03/28/2024 |
| Medicare PECOS PAC ID | 3072871276 |
|---|---|
| Medicare Enrollment ID | O20171228001478 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902329469 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Starla C Ricks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487989661 PECOS PAC ID: 8224218094 Enrollment ID: I20110210000999 |
| Provider Name | Perry D Guthrie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477939882 PECOS PAC ID: 1254634850 Enrollment ID: I20160713002017 |
| Provider Name | Sarah K Lino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407305618 PECOS PAC ID: 4284913443 Enrollment ID: I20161111000953 |
| Provider Name | Rachot K Vacharothone |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548228497 PECOS PAC ID: 9931013745 Enrollment ID: I20180420001526 |
| Provider Name | Gabriel Bayi Ekortarh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922478890 PECOS PAC ID: 3476853250 Enrollment ID: I20190528001707 |
| Provider Name | Josie Cervantes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619433307 PECOS PAC ID: 1557694718 Enrollment ID: I20190604001094 |
| Provider Name | Melissa Ann Knox |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780354092 PECOS PAC ID: 1355721382 Enrollment ID: I20220707002231 |
| Provider Name | Olyna Marie Agee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518692771 PECOS PAC ID: 9032480660 Enrollment ID: I20221004003104 |
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