| Pro-health Wellness Group | |
|
3376 S Eastern Ave # 188a Las Vegas NV 89169-3380 | |
| (702) 490-9009 | |
| (866) 737-6147 |
| Full Name | Pro-health Wellness Group |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 3376 S Eastern Ave # 188a, Las Vegas, Nevada |
| Authorized Official Name and Position | Keisha Graham (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 7024909009 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pro-health Wellness Group 2620 S Maryland Pkwy # 14-199 Las Vegas NV 89109-8300 Ph: (702) 490-9009 | Pro-health Wellness Group 3376 S Eastern Ave # 188a Las Vegas NV 89169-3380 Ph: (702) 490-9009 |
| NPI Number | 1013330695 |
|---|---|
| Provider Enumeration Date | 02/02/2014 |
| Last Update Date | 07/18/2023 |
| Certification Date | 07/18/2023 |
| Medicare PECOS PAC ID | 4688979909 |
|---|---|
| Medicare Enrollment ID | O20160224002917 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013330695 | NPI | - | NPPES |
| 1015873316 | Medicaid | NV | |
| 1063780500 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| Provider Name | Mary Grace G Gaerlan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215237110 PECOS PAC ID: 0042492910 Enrollment ID: I20110314000871 |
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