1346251519 NPI number — FAYLONA GOLLARD KAUSHAL NYAMUSWA & PARK LTD

Table of content: DR. PATRICIA M. HART M.D. (NPI 1417956822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346251519 NPI number — FAYLONA GOLLARD KAUSHAL NYAMUSWA & PARK LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAYLONA GOLLARD KAUSHAL NYAMUSWA & PARK 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:
Provider Other Organization Name Type Code:
6
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:
1346251519
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
58 N PECOS RD
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:
89074-7319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-822-2000
Provider Business Mailing Address Fax Number:
702-938-2238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 SHADOW LN
Provider Second Line Business Practice Location Address:
#300
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-822-2000
Provider Business Practice Location Address Fax Number:
702-938-2238
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOLLARD
Authorized Official First Name:
RUSSELL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER PARTNER
Authorized Official Telephone Number:
702-822-2000

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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