1417599184 NPI number — SILVER STATE HEALTH SERVICES

Table of content: (NPI 1417599184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417599184 NPI number — SILVER STATE HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SILVER STATE HEALTH SERVICES
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:
1417599184
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2965 S JONES BLVD STE C
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:
89146-5606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-410-9195
Provider Business Mailing Address Fax Number:
702-471-0421

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1430 E CALVADA BLVD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAHRUMP
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89048-5851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-410-9195
Provider Business Practice Location Address Fax Number:
702-471-0421
Provider Enumeration Date:
10/14/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MAH
Authorized Official First Name:
PAULINE
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
702-808-5739

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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