Provider Demographics
NPI:1194936658
Name:VEGAS VALLEY MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:VEGAS VALLEY MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:KOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-645-8555
Mailing Address - Street 1:4830 W LONE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-2239
Mailing Address - Country:US
Mailing Address - Phone:702-645-8555
Mailing Address - Fax:702-645-2828
Practice Address - Street 1:4830 W LONE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2239
Practice Address - Country:US
Practice Address - Phone:702-645-8555
Practice Address - Fax:702-645-2828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11112207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty