Provider Demographics
NPI:1184796054
Name:NEVADA ASSOCIATION OF CRITICAL CARE SURGEONS, LTD
Entity type:Organization
Organization Name:NEVADA ASSOCIATION OF CRITICAL CARE SURGEONS, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:SHERMAN
Authorized Official - Last Name:TATE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:702-382-5343
Mailing Address - Street 1:PO BOX 270609
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89127-4609
Mailing Address - Country:US
Mailing Address - Phone:702-382-5343
Mailing Address - Fax:702-388-2922
Practice Address - Street 1:501 S RANCHO DR
Practice Address - Street 2:SUITE E 32
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4833
Practice Address - Country:US
Practice Address - Phone:702-382-5343
Practice Address - Fax:702-388-2922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5717208600000X, 2086S0102X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A47091Medicare UPIN
NVVWCHLQMedicare PIN