Provider Demographics
NPI:1487066072
Name:A THIRD HAND
Entity type:Organization
Organization Name:A THIRD HAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LAVOR
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:702-985-8297
Mailing Address - Street 1:9806 RED DEER ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89143-1155
Mailing Address - Country:US
Mailing Address - Phone:702-985-8297
Mailing Address - Fax:702-478-9114
Practice Address - Street 1:9806 RED DEER ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89143
Practice Address - Country:US
Practice Address - Phone:702-985-8297
Practice Address - Fax:702-478-9114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-30
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV132674246ZC0007X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV132674OtherNBSTSA #