1720037799 NPI number — NORTH VISTA HOSPITAL LLC

Table of content: (NPI 1720037799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720037799 NPI number — NORTH VISTA HOSPITAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH VISTA HOSPITAL LLC
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:
1720037799
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1409 E LAKE MEAD BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89030-7120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-649-7711
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1409 E LAKE MEAD BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89030-7120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-649-7711
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DOAN
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING ASSOCIATE GENERAL COUNSEL
Authorized Official Telephone Number:
310-259-4706

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  649HOS12 , 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: 0381966 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100502299 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100502300 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2000051340A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 913275900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200327790A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 33224871 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 48475254 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP33711 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100502301 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1704989 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2900005 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 645868 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 807122600 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 304744870 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP43711 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 752632600 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110529100 . 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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