Basic Information
| Provider Information | |||||||||
| NPI: | 1184050916 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BOULDER CITY HOSPITAL INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 ADAMS BLVD | ||||||||
| Address2: | |||||||||
| City: | BOULDER CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890052213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022934111 | ||||||||
| FaxNumber: | 7022930430 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 ADAMS BLVD | ||||||||
| Address2: | |||||||||
| City: | BOULDER CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890052213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022934111 | ||||||||
| FaxNumber: | 7022930430 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2013 | ||||||||
| LastUpdateDate: | 07/29/2014 | ||||||||
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| AuthorizedOfficialLastName: | BELETE | ||||||||
| AuthorizedOfficialFirstName: | FREZEWED | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 7022934111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BOULDER CITY HOSPITAL INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 633RUH-18 | NV | Y | Hospitals | General Acute Care Hospital | Critical Access |
No ID Information.