1164370763 NPI number — LAS VEGAS VIP URGENT CARE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164370763 NPI number — LAS VEGAS VIP URGENT CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAS VEGAS VIP URGENT CARE, LLC
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:
Provider Other Organization Name Type Code:
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:
1164370763
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7435 S. EASTERN AVE, STE 105
Provider Second Line Business Mailing Address:
#142
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89123-1505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-252-5144
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2971 S SAMMY DAVIS JR DR
Provider Second Line Business Practice Location Address:
UNIT 130 & 132
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89109-1196
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-802-0243
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2026

Additional Information

Authorized Official

Authorized Official Last Name:
HASS
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
Authorized Official Title or Position:
NURSE PRACTITIONER
Authorized Official Telephone Number:
219-252-5144

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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