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DSH290007Z UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA (Terminated)
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Main Details
Name
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA
Subdivision Name
UMC PRIMARY CARE - RANCHO/CRAIG
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH290007Z
Medicare Provider Number
290007
Outpatient Facility Provider Number
290007
Additional Details
Current Program Status
Terminated
Registration Date
7/9/2014
Participating Start Date
10/1/2014
Participating Approval Date
8/29/2014
Last Recertification Date
9/16/2019
Termination Date
Termination Reason
7/1/2020
Site closure
Contacts
Authorizing Official
University Medical Center of Southern Nevada
Mason Van Houweling, CEO
(702) 383-3862
Primary Contact
University Medical Center of Southern Nevada
Jamie King, Director, Pharmaceutical Services
(702) 383-3791
Addresses
Street Address
4233 N RANCHO DRIVE
LAS VEGAS, NV 89130
Billing Address
University Medical Center of Southern Nevada
1800 W Charleston Blvd.
Las Vegas, NV 89102
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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