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NPI Code Detail

MEDICARE: MAGDALENE CLINICAL CONSULTING, INC.

MEDICARE: MAGDALENE CLINICAL CONSULTING, INC.
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
1251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1APRN002022OTHERNVSTATE LICENSE

General Provider Information

NPI Number : 1629542220
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAGDALENE CLINICAL CONSULTING, INC.
Provider Business Mailing Address
First Line : 3127 E WARM SPRINGS RD STE 300
Second Line :
City : LAS VEGAS
State : NV
Zip : 89120-3134
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3127 E WARM SPRINGS RD STE 300
Second Line :
City : LAS VEGAS
State : NV
Zip : 89120-3134
Country : US
Telephone Number : 702-850-8700
Fax Number :
Authorized Official
Title or Position : BILLING SERVICES
Name : MELISSA DOLECKI
Credential : CPB
Telephone Number : 814-271-2011
Provider Enumeration Date : 01/16/2019
Last Update Date : 01/25/2019

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