MEDICARE: UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1720654106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA

Provider Business Mailing Address
First Line	:	1800 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2386
Country	:	US
Telephone Number	:	702-383-1899
Fax Number	:

Provider Business Practice Location Address
First Line	:	5757 WAYNE NEWTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89111-8037
Country	:	US
Telephone Number	:	702-383-2527
Fax Number	:	702-383-1991

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	WILLIAM MASON VANHOUWELING
Credential	:
Telephone Number	:	702-383-2000

Provider Enumeration Date	:	05/27/2021
Last Update Date	:	05/27/2021

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