MEDICARE: CALEB OGDEN PINEGAR D.O., A.T.C.

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	2255A2300X	Athletic Trainer	020702009	UT
2	207X00000X	Orthopaedic Surgery Physician	DO2241	NV

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

General Provider Information

NPI Number	:	1588793533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALEB OGDEN PINEGAR D.O., A.T.C.

Provider Business Mailing Address
First Line	:	2779 W HORIZON RIDGE PKWY STE 200
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-4186
Country	:	US
Telephone Number	:	702-990-2290
Fax Number	:	702-990-2297

Provider Business Practice Location Address
First Line	:	2779 W HORIZON RIDGE PKWY STE 200
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-4186
Country	:	US
Telephone Number	:	702-990-2290
Fax Number	:	702-990-2297

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	09/13/2018

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