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NPI Code Detail

MEDICARE: SPARKS FAMILY MEDICINE LTD

MEDICARE: SPARKS FAMILY MEDICINE LTD
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
1207Q00000XFamily Medicine PhysicianP07-02616-B-102535NV

General Provider Information

NPI Number : 1912003054
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPARKS FAMILY MEDICINE LTD
Provider Business Mailing Address
First Line : 410 S RAMPART BLVD STE 390
Second Line :
City : LAS VEGAS
State : NV
Zip : 89145-5749
Country : US
Telephone Number : 702-722-2200
Fax Number : 702-722-2201
Provider Business Practice Location Address
First Line : 410 S RAMPART BLVD STE 390
Second Line :
City : LAS VEGAS
State : NV
Zip : 89145-5749
Country : US
Telephone Number : 702-722-2200
Fax Number : 702-722-2201
Authorized Official
Title or Position : ADMINISTRATOR
Name : BRETT W SPARKS
Credential :
Telephone Number : 702-813-7701
Provider Enumeration Date : 09/16/2006
Last Update Date : 12/05/2023

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Directions to “SPARKS FAMILY MEDICINE LTD ” Practice Location

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