Active NPI
Boulder City Hospital Inc
- Critical Access Hospital
- Boulder City, NV
National Provider Identifier
1124320726
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Critical Access Hospital
- License
- 633RUH-16
- Legal business name
- BOULDER CITY HOSPITAL INC
- Practice address
- 901 Adams Blvd
Boulder City, NV 89005-2213 - Phone
- (702) 293-4111
- Fax
- (702) 294-5732
- NPI assigned
- Dec 2, 2010
- Organization subpart
- Yes
- Parent organization
- BOULDER CITY HOSPITAL INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Frezewed Belete
- Title
- Controller
- Phone
- (702) 293-4111
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Access Hospital | 282NC0060X | 633RUH-16 | NV | Primary |
Addresses
Primary practice location
901 Adams Blvd
Boulder City, NV 89005-2213
Mailing address
901 Adams Blvd
Boulder City, NV 89005-2213
Phone (702) 293-4111
Other names 1
- Boulder City Hospital Swing Bed
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220803002099 | NV | Part A Provider - Critical Access Hospital | 7618953795 | Practice locations: Boulder City, NV |
Hospital certification: CCN 29Z309
- Legal name
- BOULDER CITY HOSPITAL INC
- Organization structure
- Corporation
- Incorporated
- Apr 15, 1954 in NV
- Enrollment address
- 901 Adams Blvd
Boulder City, NV 89005-2213
Related certifications (CCN) 1
Facilities connected through Provider of Services related, parent or unit certification numbers.
Other NPIs with the same Medicare PAC ID 4
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider Directory- Part of
- Boulder City Hospital Inc
Locations
901 Adams Blvd
Boulder City, NV 89005
Phone (702) 293-4111
Ownership & related parties
All disclosed owners & managing parties 5
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Frezewed Belete | W-2 Managing Employee | Jan 1, 2009 | |
| Margaret Caspar | Other | Apr 1, 2011 | |
| Robert Kenney | Other | Jan 1, 2018 | |
| Thomas Maher | Corporate Officer | Apr 16, 2007 | |
| W-2 Managing Employee | Apr 16, 2007 | 100% | |
| Douglas Lewis | Corporate Officer | Jan 1, 2015 | |
| W-2 Managing Employee | Jan 1, 2015 |
Practitioners & affiliated clinicians
Affiliated clinicians 1
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1291248000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1321920000000",
"number": "1124320726",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "901 ADAMS BLVD",
"city": "BOULDER CITY",
"state": "NV",
"postal_code": "890052213",
"telephone_number": "702-293-4111",
"fax_number": "702-294-5732"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "901 ADAMS BLVD",
"city": "BOULDER CITY",
"state": "NV",
"postal_code": "890052213",
"telephone_number": "702-293-4111",
"fax_number": "702-294-5732"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BOULDER CITY HOSPITAL INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "BOULDER CITY HOSPITAL INC",
"enumeration_date": "2010-12-02",
"last_updated": "2011-11-22",
"status": "A",
"authorized_official_last_name": "BELETE",
"authorized_official_first_name": "FREZEWED",
"authorized_official_title_or_position": "CONTROLLER",
"authorized_official_telephone_number": "702-293-4111",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "282NC0060X",
"taxonomy_group": "",
"desc": "General Acute Care Hospital, Critical Access",
"state": "NV",
"license": "633RUH-16",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Boulder City Hospital Swing Bed",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Boulder City, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.