Provider Demographics
NPI:1093945149
Name:RICHARD HODNETT MD PC
Entity Type:Organization
Organization Name:RICHARD HODNETT MD PC
Other - Org Name:LYMPHATIC CENTERS OF LAS VEGAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:HODNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-507-9911
Mailing Address - Street 1:6332 S RAINBOW BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-3234
Mailing Address - Country:US
Mailing Address - Phone:702-507-9911
Mailing Address - Fax:702-891-8866
Practice Address - Street 1:6332 S RAINBOW BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3234
Practice Address - Country:US
Practice Address - Phone:702-507-9911
Practice Address - Fax:702-891-8866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCJ315AMedicare PIN