1730206780 NPI number — UNIVERSITY OF NV SCHOOL ASSOCIATES SOUTH GROUP PRACTICE SO

Table of content: (NPI 1730206780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730206780 NPI number — UNIVERSITY OF NV SCHOOL ASSOCIATES SOUTH GROUP PRACTICE SO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF NV SCHOOL ASSOCIATES SOUTH GROUP PRACTICE SO
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:
1730206780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 98528
Provider Second Line Business Mailing Address:
DEPT 401
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89193-8528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-731-9110
Provider Business Mailing Address Fax Number:
702-382-5388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
880 SEVEN HILLS DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89052-4371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-836-1221
Provider Business Practice Location Address Fax Number:
702-614-8356
Provider Enumeration Date:
03/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ZAMBONI
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
702-671-2278

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , 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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