Basic Information
| Provider Information | |||||||||
| NPI: | 1386944593 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEVADA HEALTH CENTERS INC. | ||||||||
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| OtherOrganizationName: | NEVADA HEALTH CENTERS MAMMOVAN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3325 RESEARCH WAY | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897067913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758886610 | ||||||||
| FaxNumber: | 7758884904 | ||||||||
| Practice Location | |||||||||
| Address1: | 1799 MOUNT MARIAH DR | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891061501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8775816266 | ||||||||
| FaxNumber: | 7022203679 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2010 | ||||||||
| LastUpdateDate: | 06/10/2014 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | WALTER | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7758886610 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0207X | 03-54-3392-01 | NV | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology, Mobile Mammography |
ID Information
| ID | Type | State | Issuer | Description | 1386944593 | 05 | NV | MEDICAID | 03-54-3392-01 | 01 | NV | NEVADA RADIATION CONTROL PROGRAM REGISTRIATION | OTHER | DQ468A | 01 | NV | MEDICARE ID - TYPE UNSPECIFIED | OTHER |