Provider Demographics
NPI:1912277641
Name:NORTH VISTA PHYSICIANS, INC.
Entity Type:Organization
Organization Name:NORTH VISTA PHYSICIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:VINCENZO
Authorized Official - Middle Name:
Authorized Official - Last Name:VARIALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-649-7711
Mailing Address - Street 1:1409 E LAKE MEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7120
Mailing Address - Country:US
Mailing Address - Phone:702-649-7711
Mailing Address - Fax:
Practice Address - Street 1:1815 E LAKE MEAD BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7187
Practice Address - Country:US
Practice Address - Phone:702-657-1506
Practice Address - Fax:702-657-1583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV 13268207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1912277641Medicaid
NV1912277641Medicaid