1134377153 NPI number — DIAGNOSTIC CENTER OF MEDICINE (ALLEN) LLP

Table of content: (NPI 1134377153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134377153 NPI number — DIAGNOSTIC CENTER OF MEDICINE (ALLEN) LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIAGNOSTIC CENTER OF MEDICINE (ALLEN) LLP
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:
DIAGNOSTIC CENTER OF MEDICINE
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:
1134377153
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3012 S DURANGO DR
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89117-9186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-366-1655
Provider Business Mailing Address Fax Number:
702-385-4955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5380 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:
89118-1877
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-233-3444
Provider Business Practice Location Address Fax Number:
702-233-6998
Provider Enumeration Date:
09/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
702-366-0640

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" .

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

  • Identifier: 100501975 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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