EMERGENCY MEDICINE PHYSICIANS OF CLARK UMC MCCOURT PLLC - NPI NUMBER 1427359447

Summary

Provider Name: EMERGENCY MEDICINE PHYSICIANS OF CLARK UMC MCCOURT PLLC

NPI Number: 1427359447

Clasification: Emergency Medicine (207P00000X)

Address:
1800 W CHARLESTON BLVD
LAS VEGAS, NV
ZIP 89102

Phone Number: (702) 383-2085



Detailed Information

EMERGENCY MEDICINE PHYSICIANS OF CLARK UMC MCCOURT PLLC is an emergency physician in Las Vegas, NV. The provider is an emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. The assigned NPI number for this provider is 1427359447 and is registered as an organization entity type and is a single specialty group.

The provider's business address is:

1800 W CHARLESTON BLVD
LAS VEGAS, NV
ZIP 89102-329
Phone: (702) 383-2085

The provider's authorized official is David C Packo .
The authorized official title is President and has the following contact phone number (330) 493-4443.

The enumeration date for this NPI number is 11/8/2010 and was last updated on 1/14/2013.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207P00000X Emergency Medicine Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 1427359447 MEDICAID NV
2 EI639A MEDICARE PIN NV

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1427359447 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name EMERGENCY MEDICINE PHYSICIANS OF CLARK UMC MCCOURT PLLC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 1800 W CHARLESTON BLVD The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Business Practice Location Address City Name LAS VEGAS The city name in the location address of the provider being identified.
7 Provider Business Practice Location Address State Name NV The State code in the location of the provider being identified.
8 Provider Business Practice Location Address Postal Code 891022329 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
9 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
10 Provider Business Practice Location Address Telephone Number 7023832085 The telephone number associated with the location address of the provider being identified.
11 Provider Enumeration Date 11/8/2010 The date the provider was assigned a unique identifier (assigned an NPI).
12 Last Update Date 1/14/2013 The date that a record was last updated or changed.
13 Authorized Official Last Name PACKO The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
14 Authorized Official First Name DAVID The first name of the authorized official.
15 Authorized Official Middle Name C The middle name of the authorized official.
16 Authorized Official Title or Position PRESIDENT The title or position of the authorized official.
17 Authorized Official Telephone Number 3304934443 The 10-position telephone number of the authorized official.
18 Healthcare Provider Taxonomy Code 1 207P00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
19 Healthcare Provider Primary Taxonomy Switch 1 Y
20 Other Provider Identifier 1 1427359447 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
21 Other Provider Identifier Type Code 1 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
22 Other Provider Identifier State 1 NV
23 Other Provider Identifier 2 EI639A Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
24 Other Provider Identifier Type Code 2 08 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
25 Other Provider Identifier State 2 NV
26 Is Organization Subpart N
27 Authorized Official Credential Text MD
28 Healthcare Provider Taxonomy Group 1 193400000X SINGLE SPECIALTY GROUP

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This page was last updated on: 4/19/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.