Provider Demographics
NPI:1538117361
Name:SOUTHWEST LAS VEGAS SLEEP CENTER
Entity Type:Organization
Organization Name:SOUTHWEST LAS VEGAS SLEEP CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:F
Authorized Official - Last Name:DI MARCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-732-3200
Mailing Address - Street 1:4830 W LONE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-2239
Mailing Address - Country:US
Mailing Address - Phone:702-732-3200
Mailing Address - Fax:702-549-3301
Practice Address - Street 1:4830 W LONE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2239
Practice Address - Country:US
Practice Address - Phone:702-732-3200
Practice Address - Fax:702-549-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID