Provider Demographics
NPI:1376805416
Name:DIGNITY HEALTH MEDICAL GROUP NEVADA, LLC
Entity Type:Organization
Organization Name:DIGNITY HEALTH MEDICAL GROUP NEVADA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-616-5507
Mailing Address - Street 1:2200 PASEO VERDE PKWY STE 260
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2703
Mailing Address - Country:US
Mailing Address - Phone:702-616-5801
Mailing Address - Fax:602-200-3745
Practice Address - Street 1:10001 S EASTERN AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3907
Practice Address - Country:US
Practice Address - Phone:702-616-5865
Practice Address - Fax:702-616-5828
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY HEALTH MEDICAL GROUP NEVADA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty