Provider Demographics
NPI:1942581251
Name:MORTON I HYSON M D PROF CORP
Entity Type:Organization
Organization Name:MORTON I HYSON M D PROF CORP
Other - Org Name:MORTON I HYSON, M.D PROF. CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GURU
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-476-2595
Mailing Address - Street 1:8379 W SUNSET RD STE 210
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2243
Mailing Address - Country:US
Mailing Address - Phone:725-200-3232
Mailing Address - Fax:725-200-3244
Practice Address - Street 1:701 SHADOW LANE #170
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4178
Practice Address - Country:US
Practice Address - Phone:702-387-1757
Practice Address - Fax:702-387-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084N0400X
NV60622084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019047Medicaid
NV002019047Medicaid