Provider Demographics
NPI:1558571190
Name:NEVADA DONOR NETWORK, INC.
Entity Type:Organization
Organization Name:NEVADA DONOR NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHFOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-683-6667
Mailing Address - Street 1:2055 E SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3829
Mailing Address - Country:US
Mailing Address - Phone:855-683-6667
Mailing Address - Fax:702-796-4225
Practice Address - Street 1:2055 E SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3829
Practice Address - Country:US
Practice Address - Phone:855-683-6667
Practice Address - Fax:702-796-4225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2018-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1460LIC-7291U00000X
NVNONE REQUIRED332G00000X, 335U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335U00000XSuppliersOrgan Procurement Organization
No291U00000XLaboratoriesClinical Medical Laboratory
No332G00000XSuppliersEye Bank
Provider Identifiers
StateIdentifier IDID TypeIssuer
29HL01Medicare UPIN
29HL01Medicare Oscar/Certification
29P001Medicare Oscar/Certification
29P001Medicare UPIN