1356498620 NPI number — PARAGON OUTPATIENT THERAPY SERVICES

Table of content: (NPI 1356498620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356498620 NPI number — PARAGON OUTPATIENT THERAPY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARAGON OUTPATIENT THERAPY SERVICES
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:
PARAGON HEALTHCARE
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:
1356498620
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1231 E BASIN AVE
Provider Second Line Business Mailing Address:
SUITE 7
Provider Business Mailing Address City Name:
PAHRUMP
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89060-4601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-537-2300
Provider Business Mailing Address Fax Number:
775-537-2345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 N GREEN VALLEY PKWY # 8
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89074-5885
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-914-2790
Provider Business Practice Location Address Fax Number:
702-914-5984
Provider Enumeration Date:
01/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SPEAR
Authorized Official First Name:
SAM
Authorized Official Middle Name:
W
Authorized Official Title or Position:
DIRECTOR OF SERVICES
Authorized Official Telephone Number:
702-914-2790

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 227900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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