1396056628 NPI number — SEIP ORTHOPEDICS A PROFESSIONAL CORPORATION

Table of content: (NPI 1396056628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396056628 NPI number — SEIP ORTHOPEDICS A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEIP ORTHOPEDICS A PROFESSIONAL CORPORATION
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:
SEIP ORTHOPEDIC SPECIALTY
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:
1396056628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1350 E FLAMINGO RD
Provider Second Line Business Mailing Address:
#3330
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89119-5263
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-304-1911
Provider Business Mailing Address Fax Number:
702-304-2611

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8930 W SUNSET RD
Provider Second Line Business Practice Location Address:
#350
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89148-5008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-304-1911
Provider Business Practice Location Address Fax Number:
702-304-2611
Provider Enumeration Date:
07/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SEIP
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
JAY
Authorized Official Title or Position:
ORTHOPEDIC SURGEON
Authorized Official Telephone Number:
702-304-1911

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  44210 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 002004212 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: EB474A . This is a "MEDICARE PTAN" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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