Provider Demographics
NPI:1487788873
Name:CROVETTI BONE AND JOINT INSTITUTE OF SOUTHERN NEVADA
Entity type:Organization
Organization Name:CROVETTI BONE AND JOINT INSTITUTE OF SOUTHERN NEVADA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CROVETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-990-2290
Mailing Address - Street 1:2779 W HORIZON RIDGE PKWY
Mailing Address - Street 2:STE. 200
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4380
Mailing Address - Country:US
Mailing Address - Phone:702-990-2290
Mailing Address - Fax:702-990-2297
Practice Address - Street 1:2779 W HORIZON RIDGE PKWY
Practice Address - Street 2:STE. 200
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4380
Practice Address - Country:US
Practice Address - Phone:702-990-2290
Practice Address - Fax:702-990-2297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV34434Medicare PIN