Basic Information
| Provider Information | |||||||||
| NPI: | 1376805416 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIGNITY HEALTH MEDICAL GROUP NEVADA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 PASEO VERDE PKWY STE 260 | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890522703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026165801 | ||||||||
| FaxNumber: | 6022003745 | ||||||||
| Practice Location | |||||||||
| Address1: | 10001 S EASTERN AVE | ||||||||
| Address2: | SUITE 209 | ||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890523907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026165865 | ||||||||
| FaxNumber: | 7026165828 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2012 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | WALKER | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7026165507 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | DIGNITY HEALTH MEDICAL GROUP NEVADA, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.