1598003014 NPI number — UNSOM MULTISPECIALTY GROUP PRACTICE SOUTH, INC

Table of content: (NPI 1598003014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598003014 NPI number — UNSOM MULTISPECIALTY GROUP PRACTICE SOUTH, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNSOM MULTISPECIALTY GROUP PRACTICE SOUTH, 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:
MEDSCHOOL ASSOCIATES SOUTH
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:
1598003014
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 W CHARLESTON BLVD
Provider Second Line Business Mailing Address:
SUITE 490
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89102-2325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-671-2278
Provider Business Mailing Address Fax Number:
702-671-2245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3121 S MARYLAND PKWY
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89109-2307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-650-2500
Provider Business Practice Location Address Fax Number:
702-650-2220
Provider Enumeration Date:
01/17/2013

Additional Information

Authorized Official

Authorized Official Last Name:
HANSEN
Authorized Official First Name:
JOANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
702-671-2395

Provider Taxonomy Codes

  • Taxonomy code: 2086S0120X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1184601239 . This is a "GROUP NPI" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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