MEDICARE: BOULDER CITY HOSPITAL INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center
2	282NC0060X	Critical Access Hospital

General Provider Information

NPI Number	:	1619739117
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOULDER CITY HOSPITAL INC.

Provider Business Mailing Address
First Line	:	901 ADAMS BLVD
Second Line	:
City	:	BOULDER CITY
State	:	NV
Zip	:	89005-2213
Country	:	US
Telephone Number	:	702-293-4111
Fax Number	:	702-294-5732

Provider Business Practice Location Address
First Line	:	999 ADAMS BLVD
Second Line	:
City	:	BOULDER CITY
State	:	NV
Zip	:	89005-2244
Country	:	US
Telephone Number	:	702-294-5750
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	DOUGLAS B LEWIS
Credential	:
Telephone Number	:	702-293-4111

Provider Enumeration Date	:	01/29/2024
Last Update Date	:	02/14/2024

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