Provider Demographics
NPI:1982876744
Name:SOUTH HILLS GASTROENTEROLOGY LLP
Entity Type:Organization
Organization Name:SOUTH HILLS GASTROENTEROLOGY LLP
Other - Org Name:SOUTH HILLS GASTROENTEROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CARMELO
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-858-9328
Mailing Address - Street 1:7365 PRAIRIE FALCON RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0807
Mailing Address - Country:US
Mailing Address - Phone:702-202-3431
Mailing Address - Fax:702-202-3455
Practice Address - Street 1:2625 WIGWAM PKWY
Practice Address - Street 2:SUITE 112
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7325
Practice Address - Country:US
Practice Address - Phone:702-858-9328
Practice Address - Fax:702-202-3455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8613207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1007181745OtherBUSINESS LICENSE