1710375159 NPI number — PARTIDA MEDICAL CENTER LLC

Table of content: (NPI 1710375159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710375159 NPI number — PARTIDA MEDICAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARTIDA MEDICAL CENTER LLC
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:
1710375159
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 34625
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:
89133-4625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-261-6707
Provider Business Mailing Address Fax Number:
702-261-6744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5757 WAYNE NEWTON BLVD
Provider Second Line Business Practice Location Address:
TERMINAL 1 MEZZANINE LEVEL 2
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89111-8037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-261-6707
Provider Business Practice Location Address Fax Number:
702-261-6744
Provider Enumeration Date:
01/08/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PARTIDA CORONA
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
702-261-6707

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  11639 , 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)