NPIMap

Organization Active NPI

Southwest Skin & Laser Center, Inc.

  • Dermatology Physician
  • Las Vegas, NV
National Provider Identifier
1225312150
Registry record updated Oct 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
5369 Issued in NV
Legal business name
SOUTHWEST SKIN & LASER CENTER, INC.
Practice address
2900 E Desert Inn Rd
Suite 202
Las Vegas, NV 89121-3619
Phone
(702) 731-0933
Fax
(702) 731-9928
NPI assigned
Oct 11, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2011

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

Authorized official

Name
Martin Safko, M.D.
Title
Owner
Phone
(702) 731-0933

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 5369 NV Primary

Addresses

Primary practice location

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

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
002002934MedicaidNV

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1318291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318291200000",
    "number": "1225312150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 E DESERT INN RD",
            "address_2": "SUITE 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": "SUITE 202",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891213619",
            "telephone_number": "702-731-0933",
            "fax_number": "702-731-9928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST SKIN & LASER CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-11",
        "last_updated": "2011-10-11",
        "status": "A",
        "authorized_official_last_name": "SAFKO",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-731-0933",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "NV",
            "license": "5369",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "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 11, 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.