Provider Demographics
NPI:1932745668
Name:SOUTHERN NEVADA HEALTH DISTRICT
Entity Type:Organization
Organization Name:SOUTHERN NEVADA HEALTH DISTRICT
Other - Org Name:SOUTHERN NEVADA COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-759-0636
Mailing Address - Street 1:280 S DECATUR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2936
Mailing Address - Country:US
Mailing Address - Phone:702-759-1686
Mailing Address - Fax:
Practice Address - Street 1:280 S DECATUR BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-2936
Practice Address - Country:US
Practice Address - Phone:702-759-1686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1275550212Medicaid