Provider Demographics
NPI:1013241033
Name:DR EDWARD HOFFMAN PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DR EDWARD HOFFMAN PROFESSIONAL CORPORATION
Other - Org Name:SUMMERLIN MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-243-8100
Mailing Address - Street 1:8350 W SAHARA AVE
Mailing Address - Street 2:270
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-8939
Mailing Address - Country:US
Mailing Address - Phone:702-243-8100
Mailing Address - Fax:702-360-9416
Practice Address - Street 1:8350 W SAHARA AVE
Practice Address - Street 2:270
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-8939
Practice Address - Country:US
Practice Address - Phone:702-243-8100
Practice Address - Fax:702-360-9416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVOS229261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
C95667Medicare UPIN