=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265532196
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THALGOTT, A PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2006
-----------------------------------------------------
Last Update Date | 02/07/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 S RANCHO DR #107
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89106-4806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-878-8370
-----------------------------------------------------
Fax | 702-878-9364
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 600 S RANCHO DR #107
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89106-4806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-878-8370
-----------------------------------------------------
Fax | 702-878-9364
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | JOHN S THALGOTT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-878-8370
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XS0117X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery of the Spine Physician
-----------------------------------------------------
License Number | 5357
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------