Provider Demographics
NPI:1134122021
Name:NEVADA CARDIOLOGY PROFESSIONAL ASSN
Entity type:Organization
Organization Name:NEVADA CARDIOLOGY PROFESSIONAL ASSN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PETRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-233-1000
Mailing Address - Street 1:3121 S MARYLAND PKWY
Mailing Address - Street 2:STE 512
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2310
Mailing Address - Country:US
Mailing Address - Phone:702-796-7150
Mailing Address - Fax:702-796-9071
Practice Address - Street 1:3121 S MARYLAND PKWY
Practice Address - Street 2:STE 512
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2310
Practice Address - Country:US
Practice Address - Phone:702-796-7150
Practice Address - Fax:702-796-9071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV175317600207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVWCGXWMedicare PIN