NPIMap

Organization Active NPI

Intermountain Medical Holding Nevada, Inc.

  • Hematology & Oncology Physician
  • Las Vegas, NV
National Provider Identifier
1164541512
Registry record updated Jan 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
Legal business name
INTERMOUNTAIN MEDICAL HOLDING NEVADA, INC.
Practice address
2650 N Tenaya Way Ste 201
Las Vegas, NV 89128
Phone
(702) 735-7154
Fax
(702) 869-8103
NPI assigned
Mar 28, 2007
Organization subpart
Yes
Parent organization
INTERMOUNTAIN MEDICAL HOLDINGS NEVADA, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 14, 2025

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

Authorized official

Name
Mitch Cloward
Title
Region President
Phone
(702) 216-3346

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RH0003X Primary

Addresses

Primary practice location

2650 N Tenaya Way Ste 201
Las Vegas, NV 89128

Mailing address

6355 S Buffalo Dr
Las Vegas, NV 89113-2133
Phone (702) 216-3346

Other identifiers 3

IdentifierTypeStateIssuer
1043533383MedicaidNV
1164541512MedicaidNV
1245997279MedicaidNV

Other names 1

  • Tenaya Clinic- Hematology Oncology Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Intermountain Medical Holdings Nevada Inc9 organizations share this tax ID, including this one
Part of
Intermountain Medical Holdings Nevada Inc

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.60943

NPI Registry JSON

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736812800000",
    "number": "1164541512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6355 S BUFFALO DR",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891132133",
            "telephone_number": "702-216-3346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 N TENAYA WAY STE 201",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89128",
            "telephone_number": "702-735-7154",
            "fax_number": "702-869-8103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN MEDICAL HOLDING NEVADA, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTERMOUNTAIN MEDICAL HOLDINGS NEVADA, INC",
        "enumeration_date": "2007-03-28",
        "last_updated": "2025-01-14",
        "certification_date": "2025-01-14",
        "status": "A",
        "authorized_official_last_name": "CLOWARD",
        "authorized_official_first_name": "MITCH",
        "authorized_official_title_or_position": "REGION PRESIDENT",
        "authorized_official_telephone_number": "702-216-3346"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043533383",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1164541512",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245997279",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tenaya Clinic- Hematology Oncology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jan 14, 2025; 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.