Provider Demographics
NPI:1730485475
Name:NV FIDELIS HALVORSON PC
Entity Type:Organization
Organization Name:NV FIDELIS HALVORSON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HALVORSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-408-2488
Mailing Address - Street 1:3960 HOWARD HUGHES PKWY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-5972
Mailing Address - Country:US
Mailing Address - Phone:877-408-2488
Mailing Address - Fax:866-776-6641
Practice Address - Street 1:3960 HOWARD HUGHES PKWY
Practice Address - Street 2:SUITE 500
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-5972
Practice Address - Country:US
Practice Address - Phone:877-408-2488
Practice Address - Fax:866-776-6641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty