1639180276 NPI number — RIFLEY INSTITUTE OF COSMETIC SURGERY

Table of content: SHERRI LYN SANDERS PT (NPI 1457689465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639180276 NPI number — RIFLEY INSTITUTE OF COSMETIC SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIFLEY INSTITUTE OF COSMETIC SURGERY
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:
1639180276
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 N TENAYA WAY
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89128-0652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 N TENAYA WAY
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89128-0652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-242-4616
Provider Business Practice Location Address Fax Number:
702-243-9219
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RIFLEY
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
702-242-4616

Provider Taxonomy Codes

  • Taxonomy code: 332900000X , with the licence number:  7465 , 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: 2989993 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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