Provider Demographics
NPI:1427335470
Name:IMS OF LAS VEGAS HOSPITALIST, LTD
Entity type:Organization
Organization Name:IMS OF LAS VEGAS HOSPITALIST, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-588-7373
Mailing Address - Street 1:2010 GOLDRING AVE
Mailing Address - Street 2:100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4002
Mailing Address - Country:US
Mailing Address - Phone:702-588-7373
Mailing Address - Fax:702-588-7748
Practice Address - Street 1:2010 GOLDRING AVE
Practice Address - Street 2:100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4002
Practice Address - Country:US
Practice Address - Phone:702-588-7373
Practice Address - Fax:702-588-7748
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERNAL MEDICINE SPECIALIST OF LAS VEGAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9051207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty