Provider Demographics
NPI:1801257100
Name:VA SOTHERN NEVADA
Entity type:Organization
Organization Name:VA SOTHERN NEVADA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESPIRATORY
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:702-355-5662
Mailing Address - Street 1:6375 NEWVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-3229
Mailing Address - Country:US
Mailing Address - Phone:702-355-5662
Mailing Address - Fax:
Practice Address - Street 1:6375 NEWVILLE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3229
Practice Address - Country:US
Practice Address - Phone:702-355-5662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRC382865M2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVRC38OtherNEVADA STATE BOARD OF MEDICAL EXAMINERS