Provider Demographics
NPI:1124308135
Name:ST. LOUIS MEDICAL CENTER
Entity type:Organization
Organization Name:ST. LOUIS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVEAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-699-8191
Mailing Address - Street 1:530 E SAINT LOUIS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-2558
Mailing Address - Country:US
Mailing Address - Phone:702-699-8191
Mailing Address - Fax:702-699-5721
Practice Address - Street 1:530 E SAINT LOUIS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-2558
Practice Address - Country:US
Practice Address - Phone:702-699-8191
Practice Address - Fax:702-699-5721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7874305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1154413110Medicare UPIN