Provider Demographics
NPI:1720654106
Name:UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA
Entity Type:Organization
Organization Name:UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MASON
Authorized Official - Last Name:VANHOUWELING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-383-2000
Mailing Address - Street 1:1800 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2386
Mailing Address - Country:US
Mailing Address - Phone:702-383-1899
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:89111-8037
Practice Address - Country:US
Practice Address - Phone:702-383-2527
Practice Address - Fax:702-383-1991
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care