1043647407 NPI number — UNIVERSITY OF NEVADA LAS VEGAS

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 1043647407 NPI number — UNIVERSITY OF NEVADA LAS VEGAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF NEVADA LAS VEGAS
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:
1043647407
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4505 S MARYLAND PKWY
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:
89154-9900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-895-0686
Provider Business Mailing Address Fax Number:
702-895-4316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5050 SPRING VALLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75244-3995
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-367-4845
Provider Business Practice Location Address Fax Number:
972-367-3451
Provider Enumeration Date:
10/01/2013

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIDSON
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSOCIATE VP FOR STUDENT WELLNESS
Authorized Official Telephone Number:
702-895-0136

Provider Taxonomy Codes

  • Taxonomy code: 261QS1000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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