1831261460 NPI number — CRAIG M JORGENSON MD LTD

Table of content: (NPI 1831261460)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831261460 NPI number — CRAIG M JORGENSON MD LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRAIG M JORGENSON MD LTD
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:
SOUTHERN NEVADA HOSPITALISTS
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:
1831261460
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 N GREEN VALLEY PKWY STE 440-127
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89074-6170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-233-3191
Provider Business Mailing Address Fax Number:
702-407-5645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9975 S EASTERN AVE STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89183-7950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-840-7163
Provider Business Practice Location Address Fax Number:
888-288-5030
Provider Enumeration Date:
11/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JORGENSON
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
702-279-6977

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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