Healthcare Provider Details

I. General information

NPI: 1801257100
Provider Name (Legal Business Name): VA SOTHERN NEVADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6375 NEWVILLE AVE
LAS VEGAS NV
89103-3229
US

IV. Provider business mailing address

6375 NEWVILLE AVE
LAS VEGAS NV
89103-3229
US

V. Phone/Fax

Practice location:
  • Phone: 702-355-5662
  • Fax:
Mailing address:
  • Phone: 702-355-5662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License NumberRC38
License Number StateNV

VIII. Authorized Official

Name: TRAVIS SIMPKINS
Title or Position: RESPIRATORY
Credential: RRT
Phone: 702-355-5662