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General NPI Number Information
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NPI Number | 1205834355
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Entity Type | Organization
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Legal Business Name | FGKG LLC
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 1620 RAIDERS WAY STE 140
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City | HENDERSON
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State | NV
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Zip | 89052-4631
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Country | US
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Telephone | 702-395-3555
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Fax | 877-588-8501
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Provider Business Mailing Address
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Address Line | 1620 RAIDERS WAY STE 140
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City | HENDERSON
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State | NV
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Zip | 89052-4631
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Country | US
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Telephone | 702-395-3555
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Fax | 877-588-8501
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Authorized Official
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Title or Position | OWNER
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Name | ZACH TYSON NELSON
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Credential |
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Telephone | 702-395-3355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 928474785
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License Number State | NV
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