1740605435 NPI number — MANTHEI EYE PHYSICIANS LIMITED

Table of content: (NPI 1740605435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740605435 NPI number — MANTHEI EYE PHYSICIANS LIMITED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANTHEI EYE PHYSICIANS LIMITED
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:
1740605435
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1505 WIGWAM PKWY STE 100
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:
89074-8195
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-896-6043
Provider Business Mailing Address Fax Number:
702-896-9591

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3640 S HIGHWAY 160
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
PAHRUMP
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89048-5380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-896-6043
Provider Business Practice Location Address Fax Number:
702-896-9591
Provider Enumeration Date:
03/04/2014

Additional Information

Authorized Official

Authorized Official Last Name:
NEIBAUR
Authorized Official First Name:
DARRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
702-896-6043

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1275715898 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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