MEDICARE: ENSIGN FAMILY MEDICINE 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	207Q00000X	Family Medicine Physician	10240	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	:	1659538247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENSIGN FAMILY MEDICINE LLC

Provider Business Mailing Address
First Line	:	5771 S FORT APACHE RD
Second Line	:	SUITE #100
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5626
Country	:	US
Telephone Number	:	702-951-3400
Fax Number	:	702-951-3403

Provider Business Practice Location Address
First Line	:	5771 S FORT APACHE RD
Second Line	:	SUITE #100
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5626
Country	:	US
Telephone Number	:	702-951-3400
Fax Number	:	702-951-3403

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. SANFORD F WHITE
Credential	:	M.D.
Telephone Number	:	702-951-3400

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	12/06/2010

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