Provider Demographics
NPI:1275588782
Name:MMC OF NEVADA LLC
Entity Type:Organization
Organization Name:MMC OF NEVADA LLC
Other - Org Name:MESA VIEW REGIONAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP FINANCE OP/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-221-3840
Mailing Address - Street 1:PO BOX 847743
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7743
Mailing Address - Country:US
Mailing Address - Phone:702-346-8040
Mailing Address - Fax:702-346-7031
Practice Address - Street 1:1299 BERTHA HOWE AVE
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-7500
Practice Address - Country:US
Practice Address - Phone:702-346-8040
Practice Address - Fax:702-346-7031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
NV3818HOS-3282N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXHSP33686Medicaid
NV100505424Medicaid
CAXHSP43686Medicaid
NV100505425Medicaid
AZ884024Medicaid
CAXHSP43686Medicaid
NV100505424Medicaid