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General NPI Number Information
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NPI Number | 1558153106
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Entity Type | Organization
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Legal Business Name | INTERMOUNTAIN MEDICAL HOLDING NEVADA, INC.
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Dates
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Enumeration Date | 05/20/2025
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 3131 LA CANADA ST STE 230
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City | LAS VEGAS
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State | NV
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Zip | 89169-2551
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Country | US
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Telephone | 702-732-1290
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Fax |
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Provider Business Mailing Address
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Address Line | 6355 S BUFFALO DR FL 3
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City | LAS VEGAS
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State | NV
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Zip | 89113-2133
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Country | US
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Telephone | 702-216-3346
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Fax |
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Authorized Official
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Title or Position | REGION PRESIDENT
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Name | MITCH CLOWARD
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Credential |
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Telephone | 702-216-3346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 170300000X
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Taxonomy Name | Genetic Counselor (M.S.)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number |
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License Number State |
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