1275755506 NPI number — ALLAN J STAHL MD PC

Table of content: (NPI 1275755506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275755506 NPI number — ALLAN J STAHL MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLAN J STAHL MD PC
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:
1275755506
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1930 VILLAGE CENTER CIR
Provider Second Line Business Mailing Address:
#3-124
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89134-6299
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-765-5793
Provider Business Mailing Address Fax Number:
702-254-0013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
653 N TOWN CENTER DR
Provider Second Line Business Practice Location Address:
STE 400
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89144-0514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-765-5793
Provider Business Practice Location Address Fax Number:
702-254-0013
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STAHL
Authorized Official First Name:
ALLAN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
702-765-5793

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  6419 , 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: 002019495 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: V102299 . This is a "MEDICARE PTAN" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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