Provider Demographics
NPI:1992717722
Name:INTERMOUNTAIN MEDICAL HOLDING NEVADA, INC.
Entity type:Organization
Organization Name:INTERMOUNTAIN MEDICAL HOLDING NEVADA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGION PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MITCH
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-216-3346
Mailing Address - Street 1:6355 S BUFFALO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-617-6883
Practice Address - Street 1:3131 LA CANADA ST STE 140
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-2579
Practice Address - Country:US
Practice Address - Phone:702-933-9400
Practice Address - Fax:702-933-9444
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERMOUNTAIN MEDICAL HOLDING NEVADA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-12
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1992717722Medicaid
NV1245997279Medicaid
NV1043533383Medicaid
NVCQ328AMedicare PIN
NV1233510001Medicare NSC