1114276359 NPI number — BADLY SCATTERED LAND AND CATTLE

Table of content: (NPI 1114276359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114276359 NPI number — BADLY SCATTERED LAND AND CATTLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BADLY SCATTERED LAND AND CATTLE
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:
1114276359
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6120 FELDMAN ST
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:
89118-3413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-296-4158
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1110 S 3RD ST
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:
89104-1005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-454-6176
Provider Business Practice Location Address Fax Number:
702-382-5668
Provider Enumeration Date:
09/04/2012

Additional Information

Authorized Official

Authorized Official Last Name:
TEMPLETON
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
KEITH
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
702-296-4158

Provider Taxonomy Codes

  • Taxonomy code: 343900000X , with the licence number:  NV19821004792 , 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)





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