MEDICARE: DESERT PINES FAMILY HEALTH CENTER

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
1	207Q00000X	Family Medicine Physician
2	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1497873475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT PINES FAMILY HEALTH CENTER

Provider Business Mailing Address
First Line	:	6800 W CHEYENNE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4590
Country	:	US
Telephone Number	:	702-658-8800
Fax Number	:

Provider Business Practice Location Address
First Line	:	6800 W CHEYENNE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4590
Country	:	US
Telephone Number	:	702-658-8800
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DOUGLAS B HERMANSEN
Credential	:	D.C.
Telephone Number	:	702-658-8800

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	09/11/2025

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