1134679418 NPI number — JORGENSON & KOKA LLP

Table of content: (NPI 1134679418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134679418 NPI number — JORGENSON & KOKA LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JORGENSON & KOKA 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:
ADVANCED URGENT CARE & NIGHLIGHT PEDIATRICS
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:
1134679418
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9975 S EASTERN AVE
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89183-7949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-963-6363
Provider Business Mailing Address Fax Number:
702-616-0657

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
321 N PECOS RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89074-1347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-963-6363
Provider Business Practice Location Address Fax Number:
702-616-0657
Provider Enumeration Date:
10/10/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MANUEL
Authorized Official First Name:
QUENNIE
Authorized Official Middle Name:
G
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
702-492-7208

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • 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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