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NPI Code Detail

MEDICARE: HALTHORE JOHNS PEDIATRIC NEUROLOGY

MEDICARE: HALTHORE JOHNS PEDIATRIC NEUROLOGY
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
1174400000XSpecialist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11730119413OTHERNVINDIVIDUAL NPI (HALTHORE)
21326078098OTHERNVINDIVIDUAL NPI (MALLER)
31780615013OTHERNVINDIVIDUAL NPI (JOHNS)

General Provider Information

NPI Number : 1750586038
Entity Type Code : Organization
Provider Name (Legal Business Name) : HALTHORE JOHNS PEDIATRIC NEUROLOGY
Provider Business Mailing Address
First Line : 2020 E DESERT INN RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89169-3211
Country : US
Telephone Number : 702-796-5505
Fax Number : 702-732-9830
Provider Business Practice Location Address
First Line : 2020 E DESERT INN RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89169-3211
Country : US
Telephone Number : 702-796-5505
Fax Number : 702-732-9830
Authorized Official
Title or Position : PARTNER
Name : DR. SRINIVAS HALTHORE
Credential : M.D.
Telephone Number : 702-796-5505
Provider Enumeration Date : 06/18/2007
Last Update Date : 12/28/2010

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