Provider Demographics
NPI:1982662912
Name:UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA
Entity Type:Organization
Organization Name:UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA
Other - Org Name:UMC PECCOLE 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 1:9320 W SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5351
Mailing Address - Country:US
Mailing Address - Phone:702-383-3850
Mailing Address - Fax:702-562-2816
Practice Address - Street 1:9320 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5351
Practice Address - Country:US
Practice Address - Phone:702-383-3850
Practice Address - Fax:702-562-2816
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV666HOS-23261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVE69563Medicare ID - Type Unspecified