1891710406 NPI number — RICHARD R STERETT MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891710406 NPI number — RICHARD R STERETT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STERETT
Provider First Name:
RICHARD
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1891710406
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 371540
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:
89137-1540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-383-2420
Provider Business Mailing Address Fax Number:
702-383-8402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 W CHARLESTON BLVD
Provider Second Line Business Practice Location Address:
UNIVERSITY MEDICAL CENTER
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89102-2329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-383-2420
Provider Business Practice Location Address Fax Number:
702-383-8402
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0203X , with the licence number:  6653 , 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: 1489023 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1692981 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 274899 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2019453 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8265951 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: XPY187396 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 245888 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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