Provider Demographics
NPI:1598001786
Name:VC SMITH, J E MARTIN, NANCY DONAHOE, DEMETRI K MAVROIDIS
Entity Type:Organization
Organization Name:VC SMITH, J E MARTIN, NANCY DONAHOE, DEMETRI K MAVROIDIS
Other - Org Name:CARDIOVASCULAR SURGERY OF SOUTHERN NEVADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:702-737-3808
Mailing Address - Street 1:5320 S RAINBOW BLVD
Mailing Address - Street 2:STE 282
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-1895
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5320 S RAINBOW BLVD
Practice Address - Street 2:STE 282
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1895
Practice Address - Country:US
Practice Address - Phone:702-737-3808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001394282N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access