Basic Information
| Provider Information | |||||||||
| NPI: | 1750417622 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAS VEGAS HEALTH SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 S RAINBOW BLVD | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891464006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029216829 | ||||||||
| FaxNumber: | 7029216828 | ||||||||
| Practice Location | |||||||||
| Address1: | 2600 S RAINBOW BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891464006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029216829 | ||||||||
| FaxNumber: | 7029216828 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 04/17/2009 | ||||||||
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| AuthorizedOfficialLastName: | HAMID | ||||||||
| AuthorizedOfficialFirstName: | ZAHID | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7029216829 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 11643 | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100508138 | 05 | NV | MEDICAID |