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5580 W Flamingo Rd Ste 106 Las Vegas NV 89103-0165 | |
| (725) 543-2935 | |
| (855) 903-4377 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 5580 W Flamingo Rd Ste 106, Las Vegas, Nevada |
| Authorized Official Name and Position | Lisa Anderson (PRESIDENT) |
| Authorized Official Contact | 8553806136 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 30085 Las Vegas NV 89173-0085 Ph: (855) 380-6136 | 5580 W Flamingo Rd Ste 106 Las Vegas NV 89103-0165 Ph: (725) 543-2935 |
| NPI Number | 1437909777 |
|---|---|
| Provider Enumeration Date | 03/26/2024 |
| Last Update Date | 09/16/2024 |
| Certification Date | 09/16/2024 |
| Medicare PECOS PAC ID | 8729520598 |
|---|---|
| Medicare Enrollment ID | O20240607001609 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437909777 | NPI | - | NPPES |
| Provider Name | Truong Nguyen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821663428 PECOS PAC ID: 6709281785 Enrollment ID: I20210830002153 |
| Provider Name | Shalonda N Myles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659569929 PECOS PAC ID: 5092143750 Enrollment ID: I20230308002330 |
| Provider Name | Zachariah Jon Jensen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184128175 PECOS PAC ID: 9234534322 Enrollment ID: I20240603000717 |
| Provider Name | Miranda Michelle Huepers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316579246 PECOS PAC ID: 5597296509 Enrollment ID: I20241001004545 |
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