Provider Demographics
NPI:1982150744
Name:EXECUTIVE LAS VEGAS
Entity Type:Organization
Organization Name:EXECUTIVE LAS VEGAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:JIMMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-949-5384
Mailing Address - Street 1:3950 W TOMPKINS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-5524
Mailing Address - Country:US
Mailing Address - Phone:702-646-4661
Mailing Address - Fax:
Practice Address - Street 1:3950 W TOMPKINS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-5524
Practice Address - Country:US
Practice Address - Phone:702-646-4661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi