1992130090 NPI number — LAS VEGAS KIDNEY & HYPERTENSION SPECIALISTS LLC

Table of content: (NPI 1992130090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992130090 NPI number — LAS VEGAS KIDNEY & HYPERTENSION SPECIALISTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAS VEGAS KIDNEY & HYPERTENSION SPECIALISTS 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:
1992130090
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 778435
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:
89077-8435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-818-9246
Provider Business Mailing Address Fax Number:
702-492-1728

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
229 N PECOS RD STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89074-7364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-256-3637
Provider Business Practice Location Address Fax Number:
702-629-7519
Provider Enumeration Date:
09/08/2013

Additional Information

Authorized Official

Authorized Official Last Name:
JEFIC
Authorized Official First Name:
DIJANA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
702-818-9246

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  13545 , 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)





Copyright © 2007-2025 www.npivalidator.com