Provider Demographics
NPI:1578606331
Name:GLEN J HIME, M.D., PC
Entity Type:Organization
Organization Name:GLEN J HIME, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HIME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-222-3238
Mailing Address - Street 1:6655 W SAHARA AVE
Mailing Address - Street 2:SUITE B-200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-0842
Mailing Address - Country:US
Mailing Address - Phone:702-222-3238
Mailing Address - Fax:702-221-2231
Practice Address - Street 1:6655 W SAHARA AVE
Practice Address - Street 2:SUITE B-200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0842
Practice Address - Country:US
Practice Address - Phone:702-222-3238
Practice Address - Fax:702-221-2231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7386207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2019658Medicaid
NVC46721Medicare UPIN
NV2019658Medicaid