MEDICARE: HENDERSON OB/GYN 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	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1710945092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENDERSON OB/GYN LLC

Provider Business Mailing Address
First Line	:	PO BOX 530124
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89053-0124
Country	:	US
Telephone Number	:	702-568-6108
Fax Number	:	702-568-8603

Provider Business Practice Location Address
First Line	:	98 E LAKE MEAD PKWY STE 307
Second Line	:	SUITE 307
City	:	HENDERSON
State	:	NV
Zip	:	89015-6444
Country	:	US
Telephone Number	:	702-568-6108
Fax Number	:	702-568-8603

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	ORLANDIS L. WELLS
Credential	:	M.D.
Telephone Number	:	702-568-6108

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	08/22/2020

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