1669633475 NPI number — THOMAS UMBACH MD PC

Table of content: (NPI 1669633475)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669633475 NPI number — THOMAS UMBACH MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS UMBACH 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:
1669633475
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2657 WINDMILL PKWY # 344
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89074-3384
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-802-5215
Provider Business Mailing Address Fax Number:
801-931-2044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3235 E WARM SPRINGS RD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89120-3188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-463-3300
Provider Business Practice Location Address Fax Number:
702-441-0251
Provider Enumeration Date:
06/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
UMBACH
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
WALTER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
702-463-3300

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  12712 , 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: E0387562008-4 . This is a "NEVADA STATE / CORP NUMBER" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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