Healthcare Provider Details

I. General information

NPI: 1124308135
Provider Name (Legal Business Name): ST. LOUIS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 E SAINT LOUIS AVE
LAS VEGAS NV
89104-2558
US

IV. Provider business mailing address

530 E SAINT LOUIS AVE
LAS VEGAS NV
89104-2558
US

V. Phone/Fax

Practice location:
  • Phone: 702-699-8191
  • Fax: 702-699-5721
Mailing address:
  • Phone: 702-699-8191
  • Fax: 702-699-5721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number7874
License Number StateNV

VIII. Authorized Official

Name: DR. WILLIAM ALVEAR
Title or Position: INTERNAL MEDICINE DOCTOR
Credential: M.D.
Phone: 702-699-8191