1407405145 NPI number — SUNRISE MOUNTAIN VIEW HOSPITAL, INC.

Table of content: (NPI 1407405145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407405145 NPI number — SUNRISE MOUNTAIN VIEW HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNRISE MOUNTAIN VIEW HOSPITAL, INC.
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:
1407405145
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 N TENAYA WAY
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:
89128-0436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-962-9005
Provider Business Mailing Address Fax Number:
702-962-5508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7207 ALIANTE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89084-2373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-962-5100
Provider Business Practice Location Address Fax Number:
702-962-5508
Provider Enumeration Date:
09/05/2019

Additional Information

Authorized Official

Authorized Official Last Name:
KILLIAN
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
702-812-0525

Provider Taxonomy Codes

  • Taxonomy code: 261QE0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 380329 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP32789 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP42789 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001202006 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: HS397OP , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001102006 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1002006 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: HS397IP , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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