1295959641 NPI number — SUSAN SCHWARTZ DO PC

Table of content: (NPI 1295959641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295959641 NPI number — SUSAN SCHWARTZ DO PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSAN SCHWARTZ DO PC
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:
ENT VOICE & SINUS CENTER OF NEVADA
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:
1295959641
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2911 N RAMPART # 187
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-647-2900
Provider Business Mailing Address Fax Number:
702-440-6060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8985 S PECOS RD STE 3B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89074-7163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-647-2900
Provider Business Practice Location Address Fax Number:
702-440-6060
Provider Enumeration Date:
04/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHWARTZ
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
702-647-2900

Provider Taxonomy Codes

  • Taxonomy code: 207YX0905X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 231H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100512139 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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