Provider Demographics
NPI:1881739613
Name:BOULDER CITY HOSPITAL INC
Entity type:Organization
Organization Name:BOULDER CITY HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:FREZEWED
Authorized Official - Middle Name:
Authorized Official - Last Name:BELETE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-293-4111
Mailing Address - Street 1:901 ADAMS BLVD
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005-2213
Mailing Address - Country:US
Mailing Address - Phone:702-293-4111
Mailing Address - Fax:702-294-5732
Practice Address - Street 1:901 ADAMS BLVD
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-2213
Practice Address - Country:US
Practice Address - Phone:702-293-4111
Practice Address - Fax:702-294-5732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV633HOS11282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
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StateIdentifier IDID TypeIssuer
NV100502787Medicaid
NV001102839Medicaid
NV001002839Medicaid
NV001202839Medicaid
NV002802839Medicaid
NV001902839Medicaid
NV291309Medicare Oscar/Certification