Provider Demographics
NPI:1710270707
Name:THALGOTT, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:THALGOTT, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:THALGOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-878-8370
Mailing Address - Street 1:600 S RANCHO DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4867
Mailing Address - Country:US
Mailing Address - Phone:702-878-8370
Mailing Address - Fax:
Practice Address - Street 1:600 S RANCHO DR
Practice Address - Street 2:SUITE 107
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4867
Practice Address - Country:US
Practice Address - Phone:702-878-8370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THALGOTT, A PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-24
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site