Healthcare Provider Details

I. General information

NPI: 1932477296
Provider Name (Legal Business Name): WOMENS SPECIALTY CARE, LLLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10105 BANBURRY CROSS DR SUITE 460
LAS VEGAS NV
89144-6646
US

IV. Provider business mailing address

5502 S FORT APACHE RD SUITE 100
LAS VEGAS NV
89148-7683
US

V. Phone/Fax

Practice location:
  • Phone: 702-255-3547
  • Fax: 702-255-3549
Mailing address:
  • Phone: 702-255-3547
  • Fax: 702-921-2419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number9040
License Number StateNV

VIII. Authorized Official

Name: DR. TAMMY ROSE KELLY
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 702-255-3547