Provider Demographics
NPI:1679169767
Name:EMERALD MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:EMERALD MEDICAL CENTER LLC
Other - Org Name:EMERALD MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SONICO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:702-780-5875
Mailing Address - Street 1:2950 E FLAMINGO RD STE B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5208
Mailing Address - Country:US
Mailing Address - Phone:702-780-5875
Mailing Address - Fax:702-920-8493
Practice Address - Street 1:2950 E FLAMINGO RD STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5208
Practice Address - Country:US
Practice Address - Phone:702-780-5875
Practice Address - Fax:702-920-8493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-14
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Multi-Specialty