Provider Demographics
NPI:1477995314
Name:UNIVERSITY OF NEVADA SCHOOL OF MEDICINE MULTISPECIALTY GROUP PRACTICE
Entity Type:Organization
Organization Name:UNIVERSITY OF NEVADA SCHOOL OF MEDICINE MULTISPECIALTY GROUP PRACTICE
Other - Org Name:MEDSCHOOL ASSOCIATES SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZAMBONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-671-2222
Mailing Address - Street 1:1701 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE 2015
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2325
Mailing Address - Country:US
Mailing Address - Phone:702-671-2395
Mailing Address - Fax:702-382-5388
Practice Address - Street 1:2629 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2804
Practice Address - Country:US
Practice Address - Phone:702-558-3335
Practice Address - Fax:702-650-2220
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF NEVADA SCHOOL OF MEDICINE MULTISPECIALTY GROUP PRACTICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVVWQBHVMedicare PIN