1336290964 NPI number — CITY OF LAS VEGAS

Table of content: (NPI 1336290964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336290964 NPI number — CITY OF LAS VEGAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF 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:
1336290964
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 748029
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90074-8029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
833-446-7102
Provider Business Mailing Address Fax Number:
888-972-9641

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 N CASINO CENTER BLVD
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:
89101-2944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-229-0305
Provider Business Practice Location Address Fax Number:
702-464-5748
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCDONALD
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
702-229-0305

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 003202150 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 012985600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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