MEDICARE: FORESHADOW INDUSTRIES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1114767811
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORESHADOW INDUSTRIES LLC

Provider Business Mailing Address
First Line	:	5240 SUNNY BEACH LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1390
Country	:	US
Telephone Number	:	725-724-2652
Fax Number	:

Provider Business Practice Location Address
First Line	:	6883 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1645
Country	:	US
Telephone Number	:	702-833-0430
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NATHAN GELINAS
Credential	:
Telephone Number	:	725-724-2652

Provider Enumeration Date	:	05/29/2024
Last Update Date	:	05/29/2024

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Directions to “FORESHADOW INDUSTRIES LLC ” Practice Location

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