Healthcare Provider Details

I. General information

NPI: 1750084646
Provider Name (Legal Business Name): 3LG VENTURES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1077 NEW RIVER PKWY
FALLON NV
89406-6894
US

IV. Provider business mailing address

1077 NEW RIVER PKWY
FALLON NV
89406-6894
US

V. Phone/Fax

Practice location:
  • Phone: 757-428-2747
  • Fax: 775-428-2179
Mailing address:
  • Phone: 757-428-2747
  • Fax: 775-428-2179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN RAY JENSEN
Title or Position: OWNER
Credential:
Phone: 575-522-1779