Basic Information
Provider Information | |||||||||
NPI: | 1356778492 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | BOULDER CITY HOSPITAL INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
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: | 10/03/2013 | ||||||||
LastUpdateDate: | 07/28/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BELETE | ||||||||
AuthorizedOfficialFirstName: | FREZEWED | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
AuthorizedOfficialTelephone: | 7022945711 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | BOULDER CITY HOSPITAL | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X | 633RUH-19 | NV | N |   | Hospital Units | Rehabilitation Unit |   | 282NC0060X | 633RUH-19 | NV | N |   | Hospitals | General Acute Care Hospital | Critical Access | 273R00000X | 633RUH-19 | NV | Y |   | Hospital Units | Psychiatric Unit |   |
No ID Information.