1700992971 NPI number — JACK D. CLOSE AND ASSOCIATES

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 1700992971 NPI number — JACK D. CLOSE AND ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JACK D. CLOSE AND ASSOCIATES
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:
1700992971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3650 S EASTERN AVE
Provider Second Line Business Mailing Address:
#100
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89109-3379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-731-6873
Provider Business Mailing Address Fax Number:
702-731-2565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7373 PEAK DR
Provider Second Line Business Practice Location Address:
#230
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89128-9003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-215-4353
Provider Business Practice Location Address Fax Number:
702-215-4356
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CLOSE
Authorized Official First Name:
JACK
Authorized Official Middle Name:
DEAN
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
702-731-6873

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  57 , 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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