Basic Information
| Provider Information | |||||||||
| NPI: | 1164514931 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SKIN CHECK SUMMERLIN LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9416 DEL WEBB BLVD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024507546 | ||||||||
| FaxNumber: | 7023603990 | ||||||||
| Practice Location | |||||||||
| Address1: | 9416 DEL WEBB BLVD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891448314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024507546 | ||||||||
| FaxNumber: | 7023603990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HEMSTREET | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 7024507546 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.