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NPI Code Detail

MEDICARE: LAS VEGAS KIDNEY CLINIC INC.

MEDICARE: LAS VEGAS KIDNEY CLINIC INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM2500XMedical Specialty Clinic/Center3221ESR3NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245234145
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAS VEGAS KIDNEY CLINIC INC.
Provider Business Mailing Address
First Line : 1905 CIVIC CENTER DR
Second Line : STE 201
City : NORTH LAS VEGAS
State : NV
Zip : 89030-7116
Country : US
Telephone Number : 702-214-9516
Fax Number : 702-214-9415
Provider Business Practice Location Address
First Line : 1905 CIVIC CENTER DR
Second Line : STE 201
City : NORTH LAS VEGAS
State : NV
Zip : 89030-7116
Country : US
Telephone Number : 702-214-9516
Fax Number : 702-214-9415
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. GALEN ROBERT BENNETT
Credential : BSBA
Telephone Number : 702-214-9516
Provider Enumeration Date : 06/08/2005
Last Update Date : 06/06/2008

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Directions to “LAS VEGAS KIDNEY CLINIC INC. ” Practice Location

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