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NPI Code Detail

MEDICARE: INTERMOUNTAIN MEDICAL HOLDING NEVADA, INC.

MEDICARE: INTERMOUNTAIN MEDICAL HOLDING NEVADA, INC.
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
1207RH0003XHematology & Oncology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1992717722
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTERMOUNTAIN MEDICAL HOLDING NEVADA, INC.
Provider Business Mailing Address
First Line : 6355 S BUFFALO DR FL 3
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-2133
Country : US
Telephone Number : 702-216-3346
Fax Number :
Provider Business Practice Location Address
First Line : 2350 CORPORATE CIR STE 100
Second Line :
City : HENDERSON
State : NV
Zip : 89074-7738
Country : US
Telephone Number : 702-968-7210
Fax Number : 702-735-7153
Authorized Official
Title or Position : REGION PRESIDENT
Name : MITCH CLOWARD
Credential :
Telephone Number : 702-216-3346
Provider Enumeration Date : 08/12/2006
Last Update Date : 03/04/2026

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