NPIMap

Organization Active NPI

Southwest Dermatology Institute LTD

  • Specialist
  • Las Vegas, NV
National Provider Identifier
1114073285
Registry record updated Oct 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
5369 Issued in NV
Legal business name
SOUTHWEST DERMATOLOGY INSTITUTE LTD
Practice address
2900 E Desert Inn Rd
202
Las Vegas, NV 89121-3619
Phone
(702) 731-0933
Fax
(702) 731-9928
NPI assigned
Jan 25, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Martin J Safko, M.D.NPI 1255496014
Title
Provider
Phone
(702) 731-0933

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 5369 NV Primary

Addresses

Primary practice location

2900 E Desert Inn Rd
202
Las Vegas, NV 89121-3619

Mailing address

2900 E Desert Inn Rd
202
Las Vegas, NV 89121-3619
Phone (702) 731-0933

Other identifiers 2

IdentifierTypeStateIssuer
1255496014OtherNVNPI
002002934MedicaidNV

National Provider Directory

National Provider Directory

Locations

2900 E Desert Inn Rd
Ste 202
Las Vegas, NV 89121
Phone (702) 731-0933

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319068800000",
    "number": "1114073285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 E DESERT INN RD",
            "address_2": "202",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891213619",
            "telephone_number": "702-731-0933",
            "fax_number": "702-731-9928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 E DESERT INN RD",
            "address_2": "202",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891213619",
            "telephone_number": "702-731-0933",
            "fax_number": "702-731-9928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST DERMATOLOGY INSTITUTE LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2011-10-20",
        "status": "A",
        "authorized_official_last_name": "SAFKO",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "702-731-0933",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NV",
            "license": "5369",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1255496014",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002002934",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.