1841277209 NPI number — FREMONT WOMEN'S HEALTH, LLC

Table of content: (NPI 1841277209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841277209 NPI number — FREMONT WOMEN'S HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FREMONT WOMEN'S HEALTH, 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:
FREMONT WOMENS HEALTH CARE
Provider Other Organization Name Type Code:
4
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:
1841277209
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 612
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:
89125-0612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-671-6800
Provider Business Mailing Address Fax Number:
702-671-6883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3150 N TENAYA WAY
Provider Second Line Business Practice Location Address:
STE 635
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89128-0443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-870-2939
Provider Business Practice Location Address Fax Number:
702-870-2826
Provider Enumeration Date:
12/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GRIFFIN
Authorized Official First Name:
JON
Authorized Official Middle Name:
GREG
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
702-671-6800

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2471S1302X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LX0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100507673 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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