=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821667973
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNRISE MOUNTAIN VIEW HOSPITAL, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2021
-----------------------------------------------------
Last Update Date | 06/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9860 WEST SKYE CANYON PARK DRIVE
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-962-9005
-----------------------------------------------------
Fax | 702-962-5508
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3100 N TENAYA WAY
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89128-0436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-962-9005
-----------------------------------------------------
Fax | 702-962-5508
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MATTHEW COVA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-962-9005
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0002X
-----------------------------------------------------
Taxonomy Name | Emergency Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------