=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699420596
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | I-STAT PROVIDERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2022
-----------------------------------------------------
Last Update Date | 03/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4700 LAS VEGAS BLVD N
-----------------------------------------------------
City | NELLIS AFB
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89191-6600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-290-1056
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6260 TUCKAWAY COVE AVE
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89139-6269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-290-1056
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RAJEEV KALRA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 626-290-1056
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------