Provider Demographics
NPI:1295079978
Name:ACCELLENCE LAS VEGAS
Entity type:Organization
Organization Name:ACCELLENCE LAS VEGAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOWITT
Authorized Official - Suffix:
Authorized Official - Credentials:RRT, ATP
Authorized Official - Phone:775-787-8880
Mailing Address - Street 1:35 N EDISON WAY STE 37
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2352
Mailing Address - Country:US
Mailing Address - Phone:775-787-8880
Mailing Address - Fax:775-352-9333
Practice Address - Street 1:4815 W RUSSELL RD
Practice Address - Street 2:STE 4D
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-6241
Practice Address - Country:US
Practice Address - Phone:702-740-4138
Practice Address - Fax:702-740-4153
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACCELLENCE RENO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1000087786332BX2000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003316057Medicaid
NV003316057Medicaid