Basic Information
| Provider Information | |||||||||
| NPI: | 1396722880 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | J COREY BROWN MD FREMONT MEDICAL CENTER LTD | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HCPNV - FREMONT INPATIENT TEAM | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 98978 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891938978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7025072430 | ||||||||
| FaxNumber: | 7026716883 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 S RAINBOW BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891456231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026716819 | ||||||||
| FaxNumber: | 7026716851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2005 | ||||||||
| LastUpdateDate: | 06/10/2011 | ||||||||
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| AuthorizedOfficialLastName: | SPINDLER | ||||||||
| AuthorizedOfficialFirstName: | LANCE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | SR. VP OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 7029328520 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100508175 | 05 | NV | MEDICAID |