| Park Hill Family Practice | |
|
3211 W Charleston Blvd Las Vegas NV 89102-1953 | |
| (702) 871-3730 | |
| (702) 871-7379 |
| Full Name | Park Hill Family Practice |
|---|---|
| Speciality | Physician Assistant |
| Location | 3211 W Charleston Blvd, Las Vegas, Nevada |
| Authorized Official Name and Position | Charlezetta Roberson (PHYSICIAN ASSISTANT) |
| Authorized Official Contact | 7028713730 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Park Hill Family Practice 3211 W Charleston Blvd Las Vegas NV 89102-1953 Ph: (702) 871-3730 | Park Hill Family Practice 3211 W Charleston Blvd Las Vegas NV 89102-1953 Ph: (702) 871-3730 |
| NPI Number | 1235309030 |
|---|---|
| Provider Enumeration Date | 03/07/2008 |
| Last Update Date | 04/05/2019 |
| Medicare PECOS PAC ID | 6002994688 |
|---|---|
| Medicare Enrollment ID | O20080422000901 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235309030 | NPI | - | NPPES |
| 2402116 | Medicaid | NV |
| Provider Name | Terry L Wong |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1578650867 PECOS PAC ID: 5597846311 Enrollment ID: I20080118000185 |
| Provider Name | Darryl L Fortson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538255823 PECOS PAC ID: 4587615471 Enrollment ID: I20150330000417 |
| Provider Name | Sam Zand |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1528485570 PECOS PAC ID: 1557581352 Enrollment ID: I20170822003558 |
| Provider Name | Brenda Gaile Primero |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831613025 PECOS PAC ID: 7618241670 Enrollment ID: I20170914003555 |
| Provider Name | Genevie Kneir |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760922017 PECOS PAC ID: 1951660810 Enrollment ID: I20180123000009 |
| Provider Name | Denese A Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578060042 PECOS PAC ID: 8820352628 Enrollment ID: I20180502002051 |
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