1982876744 NPI number — SOUTH HILLS GASTROENTEROLOGY LLP

Table of content: (NPI 1982876744)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982876744 NPI number — SOUTH HILLS GASTROENTEROLOGY LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH HILLS GASTROENTEROLOGY LLP
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:
1982876744
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7365 PRAIRIE FALCON RD
Provider Second Line Business Mailing Address:
SUITE 140
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89128-0807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-202-3431
Provider Business Mailing Address Fax Number:
702-202-3455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2625 WIGWAM PKWY
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89074-7325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-858-9328
Provider Business Practice Location Address Fax Number:
702-202-3455
Provider Enumeration Date:
04/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HERRERO
Authorized Official First Name:
CARMELO
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
702-858-9328

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  8613 , 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: 1007181745 . This is a "BUSINESS LICENSE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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