Provider Demographics
NPI:1508378977
Name:HEMOSTASIS AND THROMBOSIS CENTER OF NEVADA
Entity Type:Organization
Organization Name:HEMOSTASIS AND THROMBOSIS CENTER OF NEVADA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FEDERIZO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:702-506-8199
Mailing Address - Street 1:8352 W WARM SPRINGS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-3629
Mailing Address - Country:US
Mailing Address - Phone:702-330-0555
Mailing Address - Fax:702-832-1128
Practice Address - Street 1:8352 W WARM SPRINGS RD STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113
Practice Address - Country:US
Practice Address - Phone:702-330-0555
Practice Address - Fax:702-832-1128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
No163WH0500XNursing Service ProvidersRegistered NurseHemodialysisGroup - Multi-Specialty
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Multi-Specialty
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty