Organization
RED ROCK AT SMOKE RANCH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAVELLE HARDIN (CREDENTIALING COORDINATOR)
(615) 344-8203
Entity
Organization
Contact information
Practice address
7130 SMOKE RANCH, LAS VEGAS, NV 89128-8391
(707) 588-7999
(702) 256-0809
Mailing address
7130 SMOKE RANCH, LAS VEGAS, NV 89128-8391
(707) 588-7999
(702) 256-0809
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100510663
—
NV
Enumeration date
09/07/2006
Last updated
10/17/2008
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