Healthcare Provider Details

I. General information

NPI: 1972624096
Provider Name (Legal Business Name): THOMAS JAMES RAINFORD A.A. BC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 E SAHARA AVE
LAS VEGAS NV
89104-1989
US

IV. Provider business mailing address

440 E SAHARA AVE
LAS VEGAS NV
89104-1989
US

V. Phone/Fax

Practice location:
  • Phone: 702-732-8721
  • Fax: 702-732-3708
Mailing address:
  • Phone: 702-732-8721
  • Fax: 702-732-3708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number27
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: