Healthcare Provider Details

I. General information

NPI: 1831535566
Provider Name (Legal Business Name): DESERT INSTITUTE OF SPECIALTY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9339 W SUNSET RD STE 100
LAS VEGAS NV
89148-4849
US

IV. Provider business mailing address

9339 W SUNSET RD STE 100
LAS VEGAS NV
89148-4849
US

V. Phone/Fax

Practice location:
  • Phone: 702-630-3472
  • Fax:
Mailing address:
  • Phone: 702-630-3472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: GINA M CROWE
Title or Position: BILLING MANAGER
Credential:
Phone: 928-537-7011