MEDICARE: ELLIS BANDT BIRKIN KOLLINS & WONG PLLC

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	2085R0204X	Vascular & Interventional Radiology Physician
2	2085R0202X	Diagnostic Radiology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DU4981	OTHER	CA	RR MEDICARE DR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578584678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLIS BANDT BIRKIN KOLLINS & WONG PLLC

Provider Business Mailing Address
First Line	:	PO BOX 202225
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75320-2225
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7200 CATHEDRAL ROCK DR STE 230
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0440
Country	:	US
Telephone Number	:	702-623-7568
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	KAREN VAUGHN
Credential	:
Telephone Number	:	629-317-1465

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	03/26/2026

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Directions to “ELLIS BANDT BIRKIN KOLLINS & WONG PLLC ” Practice Location

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