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General NPI Number Information
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NPI Number | 1841613650
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Entity Type | Organization
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Legal Business Name | NOMMIS CONSULTANTS
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Dates
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Enumeration Date | 01/30/2014
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Last Update Date | 01/30/2014
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Provider Practice Location Address
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Address Line | 4550 E CHARLESTON BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89104-5525
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Country | US
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Telephone | 702-785-4114
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Fax |
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Provider Business Mailing Address
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Address Line | 6421 ABERDEEN LN
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City | LAS VEGAS
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State | NV
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Zip | 89107-1268
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | SIMMON WILCOX
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Credential | MD
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Telephone | 702-785-4114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 2009007880
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | MD033724E
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 6968998-1205
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License Number State | UT
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Taxonomy #4
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 11588
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License Number State | NV
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Taxonomy #5
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 11588
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License Number State | NV
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