1750354239 NPI number — PAUL TOMASIC

Table of content: PAUL TOMASIC (NPI 1750354239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750354239 NPI number — PAUL TOMASIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOMASIC
Provider First Name:
PAUL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

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:
1750354239
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9260 W SUNSET RD
Provider Second Line Business Mailing Address:
STE. 200
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89148-4858
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-255-3547
Provider Business Mailing Address Fax Number:
702-921-2419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9260 W SUNSET RD STE 207
Provider Second Line Business Practice Location Address:
STE. 207
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89148-4903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-304-5756
Provider Business Practice Location Address Fax Number:
702-906-0933
Provider Enumeration Date:
02/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  11487 , 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: 100506633 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100506632 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1750354239 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: VWCHKL . This is a "NORIDIAN" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 100500023 . This is a "NV MEDICAID" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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