Basic Information
Provider Information | |||||||||
NPI: | 1891768214 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SPINOWITZ | ||||||||
FirstName: | HOWARD | ||||||||
MiddleName: | SCOTT | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 15645 | ||||||||
Address2: |   | ||||||||
City: | LAS VEGAS | ||||||||
State: | NV | ||||||||
PostalCode: | 891145645 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7028775310 | ||||||||
FaxNumber: | 7028775310 | ||||||||
Practice Location | |||||||||
Address1: | 2450 W CHARLESTON BLVD | ||||||||
Address2: |   | ||||||||
City: | LAS VEGAS | ||||||||
State: | NV | ||||||||
PostalCode: | 89102 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7028778660 | ||||||||
FaxNumber: | 7022581322 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/08/2006 | ||||||||
LastUpdateDate: | 05/24/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 1231 | NV | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology |   |
ID Information
ID | Type | State | Issuer | Description | 200122850A | 01 | OK | OKLAHOMA MEDICAID | OTHER | 7616781 | 01 | NC | NO.CAROLINA | OTHER | 944026 | 01 | AZ | ARIZONA MEDICAID | OTHER | 1770556037 | 01 | UT | UTAH MEDICAID | OTHER | 100506401 | 05 | NV |   | MEDICAID | 1891768214 | 01 | ID | IDAHO MEDICAID | OTHER | 742958000 | 01 | MN | MINNESOTA MEDICAID | OTHER | XPY202877Q80 | 01 | NV | CALIFORNIA MEDICAID | OTHER | 102079755 0001 | 01 | NV | PENNSYLVANIA MEDICAID | OTHER |