Healthcare Provider Details

I. General information

NPI: 1285418541
Provider Name (Legal Business Name): NORTH EAST MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5580 W FLAMINGO RD STE 105
LAS VEGAS NV
89103-0165
US

IV. Provider business mailing address

2171 JUNIPERO SERRA BLVD STE 700
DALY CITY CA
94014-1982
US

V. Phone/Fax

Practice location:
  • Phone: 415-391-9686
  • Fax:
Mailing address:
  • Phone: 415-391-9686
  • Fax: 415-433-4726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EDDIE W CHAN
Title or Position: PRESIDENT & CEO
Credential:
Phone: 415-391-9686