1093945149 NPI number — RICHARD HODNETT MD PC

Table of content: (NPI 1093945149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093945149 NPI number — RICHARD HODNETT MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD HODNETT MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LYMPHATIC CENTERS OF LAS VEGAS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093945149
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6332 S RAINBOW BLVD
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89118-3234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-507-9911
Provider Business Mailing Address Fax Number:
702-891-8866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6332 S RAINBOW BLVD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89118-3234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-507-9911
Provider Business Practice Location Address Fax Number:
702-891-8866
Provider Enumeration Date:
07/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HODNETT
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
702-507-9911

Provider Taxonomy Codes

  • Taxonomy code: 2086S0122X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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