Healthcare Provider Details

I. General information

NPI: 1497198063
Provider Name (Legal Business Name): VA SOUTHERN NEVADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 PECOS RD
N LAS VEGAS NV
89086-4400
US

IV. Provider business mailing address

112 SIERRA BREEZE AVE
N LAS VEGAS NV
89031-6873
US

V. Phone/Fax

Practice location:
  • Phone: 702-791-9000
  • Fax: 702-791-9314
Mailing address:
  • Phone: 404-825-0878
  • Fax: 702-489-8221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License NumberRC2092
License Number StateNV

VIII. Authorized Official

Name: MISS NADINE HARRIS
Title or Position: HR
Credential:
Phone: 702-791-9000