Basic Information
| Provider Information | |||||||||
| NPI: | 1811412497 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOULDER CITY HOSPITAL INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 ADAMS BLVD | ||||||||
| Address2: | |||||||||
| City: | BOULDER CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890052213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022934111 | ||||||||
| FaxNumber: | 7022945732 | ||||||||
| Practice Location | |||||||||
| Address1: | 999 ADAMS BLVD | ||||||||
| Address2: | |||||||||
| City: | BOULDER CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890052244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022934111 | ||||||||
| FaxNumber: | 7022945732 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2017 | ||||||||
| LastUpdateDate: | 08/04/2017 | ||||||||
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| AuthorizedOfficialLastName: | LEWIS | ||||||||
| AuthorizedOfficialFirstName: | DOUGLAS | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7022934111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 1102839 | 05 | NV | MEDICAID |