Provider Demographics
NPI:1639180276
Name:RIFLEY INSTITUTE OF COSMETIC SURGERY
Entity Type:Organization
Organization Name:RIFLEY INSTITUTE OF COSMETIC SURGERY
Other - Org Name:WILLIAM J RIFLEY III MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RIFLEY
Authorized Official - Suffix:
Authorized Official - Credentials:NMI
Authorized Official - Phone:702-242-4616
Mailing Address - Street 1:2800 N TENAYA WAY
Mailing Address - Street 2:STE 201
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0652
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2800 N TENAYA WAY
Practice Address - Street 2:STE 201
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0652
Practice Address - Country:US
Practice Address - Phone:702-242-4616
Practice Address - Fax:702-243-9219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7465332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
2989993OtherOTHER ID NUMBER-COMMERCIAL NUMBER