Provider Demographics
NPI:1679121958
Name:PRIORITY HEALTH SYSTEM LLC
Entity Type:Organization
Organization Name:PRIORITY HEALTH SYSTEM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-468-4080
Mailing Address - Street 1:2655 S RAINBOW BLVD STE 410
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5100
Mailing Address - Country:US
Mailing Address - Phone:702-222-4339
Mailing Address - Fax:
Practice Address - Street 1:2655 S RAINBOW BLVD STE 410
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5100
Practice Address - Country:US
Practice Address - Phone:702-222-4339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty