ISD LAS VEGAS LLC NPI 1245430446

NPI Information

NPI: 1245430446
Provider Name: ISD LAS VEGAS LLC

Doing Business As: GREEN VALLEY DIALYSIS

Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
1489 W WARM SPRINGS RD
STE 122
HENDERSON, NV
ZIP 89014
Phone: (702) 450-8877
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ISD LAS VEGAS LLC is an end-stage renal disease (esrd) treatment clinic center in Henderson, NV. ISD LAS VEGAS LLC NPI is 1245430446. The provider is registered as an organization entity type.
The provider Is Doing Business As Green Valley Dialysis.

The provider's business location address is:

1489 W WARM SPRINGS RD
STE 122
HENDERSON, NV
ZIP 89014-637
Phone: (702) 450-8877
Fax: (702) 450-8887

The provider's authorized official is Samuel Wey .
The authorized official title is Vp, Licensure & Certification and has the following contact phone number (615) 341-6641.

The CLIA number assigned to this NPI record is 29D1073275 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/25/2007 and was last updated on 4/8/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. 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	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1245430446	MEDICAID	NEVADA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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