Healthcare Provider Details

I. General information

NPI: 1487947990
Provider Name (Legal Business Name): NEVADA HOSPITALIST GROUP - SUBACUTE DIVISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6970 W PATRICK LN STE 140
LAS VEGAS NV
89113-0270
US

IV. Provider business mailing address

6970 W PATRICK LN STE 140
LAS VEGAS NV
89113-0270
US

V. Phone/Fax

Practice location:
  • Phone: 702-450-1717
  • Fax: 702-947-6740
Mailing address:
  • Phone: 702-450-1717
  • Fax: 702-947-6740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: KIM KOZLOWSKI
Title or Position: EXECUTIVE DIRECTOR
Credential: RN
Phone: 702-450-1717