NPIMap

Organization Active NPI

Fife Dermatology, P.C.

  • MOHS-Micrographic Surgery Physician
  • Las Vegas, NV
National Provider Identifier
1740516699
Registry record updated Jun 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
License
13164 Issued in NV
Legal business name
FIFE DERMATOLOGY, P.C.
Practice address
6460 Medical Center St
Ste 350
Las Vegas, NV 89148-2406
Phone
(702) 255-6647
Fax
(702) 933-1444
NPI assigned
Oct 28, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2015

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

Authorized official

Name
Ms. Cindy Jones
Title
Office Manager
Phone
(702) 255-6647

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ND0101X 13164 NV Primary

Addresses

Primary practice location

6460 Medical Center St
Ste 350
Las Vegas, NV 89148-2406

Mailing address

6460 Medical Center Street
Ste 350
Las Vegas, NV 89148
Phone (702) 255-6647

Other identifiers 1

IdentifierTypeStateIssuer
1225228034OtherNVINDIVIDUAL NPI

Other names 1

  • SURGICAL DERMATOLOGY AND LASER CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091207000442 NV Part B Supplier - Clinic/Group Practice 1355480252 Receives reassigned benefits from 20 practitioners
Practice locations: Las Vegas, NV

National Provider Directory

National Provider Directory

Locations

6460 Medical Center St
Ste 200
Las Vegas, NV 89148
Phone (702) 255-6647

6460 Medical Center St
Ste 230
Las Vegas, NV 89148

Practitioners & affiliated clinicians

Practitioners 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1256688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433289600000",
    "number": "1740516699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6460 MEDICAL CENTER STREET",
            "address_2": "STE 350",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89148",
            "telephone_number": "702-255-6647",
            "fax_number": "702-933-1444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6460 MEDICAL CENTER ST",
            "address_2": "STE 350",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891482406",
            "telephone_number": "702-255-6647",
            "fax_number": "702-933-1444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIFE DERMATOLOGY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-28",
        "last_updated": "2015-06-03",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "CINDY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "702-255-6647",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NV",
            "license": "13164",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1225228034",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SURGICAL DERMATOLOGY AND LASER 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 Jun 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.