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General NPI Number Information
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NPI Number | 1992717722
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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 | 08/12/2006
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 3131 LA CANADA ST STE 140
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City | LAS VEGAS
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State | NV
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Zip | 89169-2579
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Country | US
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Telephone | 702-933-9400
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Fax | 702-933-9444
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Provider Business Mailing Address
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Address Line | 6355 S BUFFALO DR
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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 | 702-617-6883
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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