Healthcare Provider Details

I. General information

NPI: 1124535539
Provider Name (Legal Business Name): INSTAMED HEALTH PROVIDER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 03/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 E FLAMINGO RD STE 329
LAS VEGAS NV
89119-5190
US

IV. Provider business mailing address

2110 E FLAMINGO RD STE 329
LAS VEGAS NV
89119-5190
US

V. Phone/Fax

Practice location:
  • Phone: 702-800-0043
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DAVID FLOWERS
Title or Position: OPERATION MANGER
Credential:
Phone: 702-800-0043