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NPI Code Detail

MEDICARE: FREMONT WOMEN'S HEALTH, LLC

MEDICARE: FREMONT WOMEN'S HEALTH, LLC
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
12471S1302XSonography Radiologic Technologist
2363A00000XPhysician Assistant
3363LX0001XObstetrics & Gynecology Nurse Practitioner
4207V00000XObstetrics & Gynecology Physician

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 : 1255318648
Entity Type Code : Organization
Provider Name (Legal Business Name) : FREMONT WOMEN'S HEALTH, LLC
Provider Business Mailing Address
First Line : PO BOX 612
Second Line :
City : LAS VEGAS
State : NV
Zip : 89125-0612
Country : US
Telephone Number : 702-671-6800
Fax Number : 702-671-6855
Provider Business Practice Location Address
First Line : 3196 S MARYLAND PKWY
Second Line : SUITE 303
City : LAS VEGAS
State : NV
Zip : 89109-2305
Country : US
Telephone Number : 702-383-2919
Fax Number : 702-383-2886
Authorized Official
Title or Position : CEO
Name : JON GREG GRIFFIN
Credential :
Telephone Number : 702-671-6800
Provider Enumeration Date : 12/27/2005
Last Update Date : 01/15/2009

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Directions to “FREMONT WOMEN'S HEALTH, LLC ” Practice Location

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