1932160959 NPI number — REX GARN MABEY JR M.D. CHARTERED

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 1932160959 NPI number — REX GARN MABEY JR M.D. CHARTERED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REX GARN MABEY JR M.D. CHARTERED
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:
1932160959
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
08/05/2008
NPI Reactivation Date:
04/11/2011

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2881 N TENAYA WAY
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:
89128-0452
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-242-8800
Provider Business Mailing Address Fax Number:
702-242-8949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2881 N TENAYA WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89128-0452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-242-8800
Provider Business Practice Location Address Fax Number:
702-242-8949
Provider Enumeration Date:
03/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MABEY
Authorized Official First Name:
REX
Authorized Official Middle Name:
GARN
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
702-242-8800

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  5758 , 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: 2002342 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1720048549 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".