NPIMap

Organization Active NPI

Intermountain Medical Holdings Nevada Inc

Doing business as Boulder Station Medical Center

  • Primary Care Clinic/Center
  • Las Vegas, NV
National Provider Identifier
1528822194
Registry record updated Feb 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
INTERMOUNTAIN MEDICAL HOLDINGS NEVADA INC
Doing business as
Boulder Station Medical Center
Practice address
4003 Boulder Highway
Las Vegas, NV 89121
Phone
(702) 968-3265
NPI assigned
Feb 13, 2024
Last updated
Feb 13, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2024

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

Authorized official

Name
Michell Cloward
Title
President
Phone
(435) 668-4929

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

4003 Boulder Highway
Las Vegas, NV 89121

Mailing address

4003 Boulder Highway
Las Vegas, NV 89121
Phone (702) 968-3265

Other names 1

  • Boulder Station Medical Center Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
29D2298353Boulder Station Medical Center4003 Boulder Highway, Las Vegas, NV 89121Certificate of waiverJan 31, 2028

National Provider Directory

National Provider Directory
Tax ID family
Intermountain Medical Holding Nevada Inc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

NPI Registry JSON

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

{
    "created_epoch": "1707782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707782400000",
    "number": "1528822194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4003 BOULDER HIGHWAY",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89121",
            "telephone_number": "702-968-3265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4003 BOULDER HIGHWAY",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89121",
            "telephone_number": "702-968-3265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN MEDICAL HOLDINGS NEVADA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-13",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-12",
        "status": "A",
        "authorized_official_last_name": "CLOWARD",
        "authorized_official_first_name": "MICHELL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "435-668-4929"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boulder Station Medical Center",
            "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 Feb 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.