Provider Demographics
NPI:1710549829
Name:UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA
Entity Type:Organization
Organization Name:UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA
Other - Org Name:UMC BLUE DIAMOND QUICK CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MASON
Authorized Official - Last Name:VANHOUWELING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-383-2000
Mailing Address - Street 1:1800 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2386
Mailing Address - Country:US
Mailing Address - Phone:702-383-2000
Mailing Address - Fax:
Practice Address - Street 1:4760 BLUE DIAMOND RD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-7665
Practice Address - Country:US
Practice Address - Phone:702-383-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-28
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care