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NPI Code Detail

MEDICARE: REDROCK RENAL GROUP LLC

MEDICARE: REDROCK RENAL GROUP 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
1261Q00000XClinic/Center2000115.426NV

General Provider Information

NPI Number : 1144477498
Entity Type Code : Organization
Provider Name (Legal Business Name) : REDROCK RENAL GROUP LLC
Provider Business Mailing Address
First Line : 5751 S FORT APACHE RD
Second Line : SUITE 1110
City : LAS VEGAS
State : NV
Zip : 89148-5624
Country : US
Telephone Number : 702-586-0007
Fax Number : 702-586-0009
Provider Business Practice Location Address
First Line : 5751 S FORT APACHE RD
Second Line : SUITE 1110
City : LAS VEGAS
State : NV
Zip : 89148-5624
Country : US
Telephone Number : 702-586-0007
Fax Number : 702-586-0009
Authorized Official
Title or Position : CEO / ADMINISTRATOR
Name : MR. GALEN ROBERT BENNETT
Credential : BSBA
Telephone Number : 702-586-0007
Provider Enumeration Date : 08/19/2008
Last Update Date : 08/19/2008

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Directions to “REDROCK RENAL GROUP LLC ” Practice Location

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