Healthcare Provider Details

I. General information

NPI: 1659538247
Provider Name (Legal Business Name): ENSIGN FAMILY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5771 S FORT APACHE RD SUITE #100
LAS VEGAS NV
89148-5626
US

IV. Provider business mailing address

5771 S FORT APACHE RD SUITE #100
LAS VEGAS NV
89148-5626
US

V. Phone/Fax

Practice location:
  • Phone: 702-951-3400
  • Fax: 702-951-3403
Mailing address:
  • Phone: 702-951-3400
  • Fax: 702-951-3403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10240
License Number StateNV

VIII. Authorized Official

Name: DR. SANFORD F WHITE
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 702-951-3400