Provider Demographics
NPI:1811968357
Name:BOULDER CITY NEVADA
Entity type:Organization
Organization Name:BOULDER CITY NEVADA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-293-9228
Mailing Address - Street 1:1101 ELM ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005-2140
Mailing Address - Country:US
Mailing Address - Phone:702-293-9228
Mailing Address - Fax:702-293-9221
Practice Address - Street 1:1101 ELM ST
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-2140
Practice Address - Country:US
Practice Address - Phone:702-293-9228
Practice Address - Fax:702-293-9221
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOULDER CITY NEVADA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-01
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ942616Medicaid
NV003202338Medicaid
NV0000RHBBJMedicare ID - Type Unspecified