1861061723 NPI number — SOUTHERN HILLS MEDICAL CENTER, LLC

Table of content: (NPI 1861061723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861061723 NPI number — SOUTHERN HILLS MEDICAL CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN HILLS MEDICAL CENTER, 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:
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:
1861061723
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9300 W SUNSET RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89148-4844
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-916-9002
Provider Business Mailing Address Fax Number:
702-916-9009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10770 LAS VEGAS BOULEVARD SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89183-5436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-916-9002
Provider Business Practice Location Address Fax Number:
702-916-9009
Provider Enumeration Date:
06/23/2021

Additional Information

Authorized Official

Authorized Official Last Name:
LE
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
702-916-9002

Provider Taxonomy Codes

  • Taxonomy code: 261QE0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: XHSP43697 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100502481 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100502483 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100502482 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP33697 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 926769 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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