Healthcare Provider Details

I. General information

NPI: 1114276359
Provider Name (Legal Business Name): BADLY SCATTERED LAND AND CATTLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 09/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 S 3RD ST
LAS VEGAS NV
89104-1005
US

IV. Provider business mailing address

6120 FELDMAN ST
LAS VEGAS NV
89118-3413
US

V. Phone/Fax

Practice location:
  • Phone: 702-454-6176
  • Fax: 702-382-5668
Mailing address:
  • Phone: 702-296-4158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberNV19821004792
License Number StateNV

VIII. Authorized Official

Name: MR. ROBERT KEITH TEMPLETON
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 702-296-4158