Healthcare Provider Details

I. General information

NPI: 1215152020
Provider Name (Legal Business Name): BUTLER FAMILY MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 08/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 N TOWN CENTER DR SUITE 502
LAS VEGAS NV
89144-0514
US

IV. Provider business mailing address

653 N TOWN CENTER DR SUITE 502
LAS VEGAS NV
89144-0514
US

V. Phone/Fax

Practice location:
  • Phone: 702-242-4102
  • Fax: 702-242-0177
Mailing address:
  • Phone: 702-242-4102
  • Fax: 702-242-0177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6224
License Number StateNV

VIII. Authorized Official

Name: DR. RANDY H BUTLER
Title or Position: PRESIDENT
Credential: MD
Phone: 702-242-4102