Provider Demographics
NPI:1588703698
Name:DR MIRIAM & SHELDON G ADELSON CLINIC OF DRUG ABUSE TREATMENT & RESEARC
Entity type:Organization
Organization Name:DR MIRIAM & SHELDON G ADELSON CLINIC OF DRUG ABUSE TREATMENT & RESEARC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LINZY
Authorized Official - Suffix:
Authorized Official - Credentials:RN MS
Authorized Official - Phone:702-735-7900
Mailing Address - Street 1:3661 S MARYLAND PKWY
Mailing Address - Street 2:SUITE 64
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169
Mailing Address - Country:US
Mailing Address - Phone:702-735-0081
Mailing Address - Fax:
Practice Address - Street 1:3661 S MARYLAND PKWY
Practice Address - Street 2:SUITE 64
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169
Practice Address - Country:US
Practice Address - Phone:702-735-0081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2583NTC8207LA0401X
NVRA0254209207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV01702160Medicaid