Healthcare Provider Details

I. General information

NPI: 1912264524
Provider Name (Legal Business Name): MILLENNIUM HOSPITALIST COMPANY OF BOULDER CITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 ADAMS BLVD
BOULDER CITY NV
89005-2213
US

IV. Provider business mailing address

3375 S RAINBOW BLVD UNIT 80751
LAS VEGAS NV
89180-8801
US

V. Phone/Fax

Practice location:
  • Phone: 702-453-3799
  • Fax: 702-453-5741
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number13058
License Number StateNV

VIII. Authorized Official

Name: LORI LABRECQUE
Title or Position: ACCOUNTS MGR
Credential:
Phone: 702-453-3799