Provider Demographics
NPI:1114576857
Name:SOUTHERN HILLS MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:SOUTHERN HILLS MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-916-9002
Mailing Address - Street 1:9300 W SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4844
Mailing Address - Country:US
Mailing Address - Phone:702-916-9002
Mailing Address - Fax:702-916-9009
Practice Address - Street 1:3325 S FORT APACHE RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-6360
Practice Address - Country:US
Practice Address - Phone:702-962-0500
Practice Address - Fax:702-916-9009
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN HILLS MEDICAL CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502483Medicaid
AZ926769Medicaid
NV100502481Medicaid
NV100502482Medicaid
CAXHSP33697Medicaid
CAXHSP43697Medicaid