=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487457685
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BENNETT PERI-OP PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2025
-----------------------------------------------------
Last Update Date | 03/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9159 W FLAMINGO RD STE 100
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89147-6454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-984-6551
-----------------------------------------------------
Fax | 775-984-6582
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9159 W FLAMINGO RD STE 100
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89147-6454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-984-6551
-----------------------------------------------------
Fax | 775-984-6582
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | WILLIAM RALSTON MCGEE
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 702-485-5885
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------