Provider Demographics
NPI:1003322041
Name:SILVER STATE FIELD MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:SILVER STATE FIELD MEDICAL GROUP, LLC
Other - Org Name:HOME VISITING DOCTORS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DELL JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-913-9390
Mailing Address - Street 1:871 CORONADO CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3977
Mailing Address - Country:US
Mailing Address - Phone:702-913-9380
Mailing Address - Fax:
Practice Address - Street 1:871 CORONADO CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3977
Practice Address - Country:US
Practice Address - Phone:702-913-9380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty