Provider Demographics
NPI:1033743083
Name:SUMMERLIN MEDICAL
Entity Type:Organization
Organization Name:SUMMERLIN MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:
Authorized Official - Last Name:URBINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-495-3796
Mailing Address - Street 1:10300 W. CHARLESTON BLVD.
Mailing Address - Street 2:SUITE 13
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135
Mailing Address - Country:US
Mailing Address - Phone:773-495-3796
Mailing Address - Fax:888-775-0887
Practice Address - Street 1:10300 W. CHARLESTON BLVD.
Practice Address - Street 2:SUITE 13
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135
Practice Address - Country:US
Practice Address - Phone:773-495-3796
Practice Address - Fax:888-775-0887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies