Provider Demographics
NPI:1033678933
Name:ST ROSE INTEGRATED MEDICAL CENTER
Entity Type:Organization
Organization Name:ST ROSE INTEGRATED MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-405-6333
Mailing Address - Street 1:10561 JEFFREYS ST STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4267
Mailing Address - Country:US
Mailing Address - Phone:702-405-6333
Mailing Address - Fax:
Practice Address - Street 1:10561 JEFFREYS ST STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4267
Practice Address - Country:US
Practice Address - Phone:702-405-6333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty