Provider Demographics
NPI:1811412497
Name:BOULDER CITY HOSPITAL INC
Entity Type:Organization
Organization Name:BOULDER CITY HOSPITAL INC
Other - Org Name:BOULDER CITY PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-293-4111
Mailing Address - Street 1:901 ADAMS BLVD
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005-2213
Mailing Address - Country:US
Mailing Address - Phone:702-293-4111
Mailing Address - Fax:702-294-5732
Practice Address - Street 1:999 ADAMS BLVD
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-2244
Practice Address - Country:US
Practice Address - Phone:702-293-4111
Practice Address - Fax:702-294-5732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-04
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1102839Medicaid