Provider Demographics
NPI: | 1487631917 |
---|---|
Name: | HEALTHCARE PARTNERS MEDICAL GROUP COATS LTD |
Entity Type: | Organization |
Organization Name: | HEALTHCARE PARTNERS MEDICAL GROUP COATS LTD |
Other - Org Name: | INTERMOUNTAIN HEALTHCARE |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | H BARD |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | COATS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 702-216-3346 |
Mailing Address - Street 1: | PO BOX 98978 |
Mailing Address - Street 2: | |
Mailing Address - City: | LAS VEGAS |
Mailing Address - State: | NV |
Mailing Address - Zip Code: | 89193-8978 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 702-216-3346 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4880 S. WYNN RD |
Practice Address - Street 2: | |
Practice Address - City: | LAS VEGAS |
Practice Address - State: | NV |
Practice Address - Zip Code: | 89103-5406 |
Practice Address - Country: | US |
Practice Address - Phone: | 702-871-5005 |
Practice Address - Fax: | 702-671-6883 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | HEALTHCARE PARTNERS MEDICAL GROUP (COATS) LTD |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2005-12-27 |
Last Update Date: | 2021-03-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NV | 207N00000X, 207Q00000X, 207R00000X, 207RC0000X, 207RE0101X, 208000000X, 2083X0100X, 208M00000X, 213E00000X, 247100000X, 363AM0700X, 363LP2300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2083X0100X | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine | Group - Multi-Specialty |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
No | 247100000X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Group - Multi-Specialty | |
No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
No | 363LP2300X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NV | 1043533383 | Medicaid | |
NV | 1487631917 | Medicaid | |
NV | 1487631917 | Medicaid | |
NV | CQ328A | Medicare PIN |