Basic Information
| Provider Information | |||||||||
| NPI: | 1043297468 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTHCARE PARTNERS MEDICAL GROUP (COATS), LTD. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | INTERMOUNTAIN HEALTHCARE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 98978 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891938978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022163346 | ||||||||
| FaxNumber: | 7026716883 | ||||||||
| Practice Location | |||||||||
| Address1: | 5575 S DURANGO DR | ||||||||
| Address2: | #103 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891131833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024355437 | ||||||||
| FaxNumber: | 7028519640 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2005 | ||||||||
| LastUpdateDate: | 03/24/2021 | ||||||||
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| AuthorizedOfficialLastName: | COATS | ||||||||
| AuthorizedOfficialFirstName: | H BARD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7022163346 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1043297468 | 05 | NV | MEDICAID |