Provider Demographics
NPI:1013249481
Name:AIRPORT MD - LAS VEGAS
Entity Type:Organization
Organization Name:AIRPORT MD - LAS VEGAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-439-8484
Mailing Address - Street 1:5757 WAYNE NEWTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89111-5000
Mailing Address - Country:US
Mailing Address - Phone:702-261-4622
Mailing Address - Fax:
Practice Address - Street 1:5757 WAYNE NEWTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89111-5000
Practice Address - Country:US
Practice Address - Phone:702-261-4622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care