Provider Demographics
NPI:1255529590
Name:WESTSIDE CARDIOLOGY
Entity type:Organization
Organization Name:WESTSIDE CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:THERESE
Authorized Official - Last Name:BILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-255-8877
Mailing Address - Street 1:2800 N TENAYA WAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0652
Mailing Address - Country:US
Mailing Address - Phone:702-255-8877
Mailing Address - Fax:702-255-8813
Practice Address - Street 1:2800 N TENAYA WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0652
Practice Address - Country:US
Practice Address - Phone:702-255-8877
Practice Address - Fax:702-255-8813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7780174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019815Medicaid
NV002019815Medicaid
NVV38030Medicare PIN