| Zane Medical Group Llc | |
|
3455 W Craig Rd Ste C North Las Vegas NV 89032-5119 | |
| (702) 802-2011 | |
| (702) 920-8226 |
| Full Name | Zane Medical Group Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3455 W Craig Rd Ste C, North Las Vegas, Nevada |
| Authorized Official Name and Position | Sussan Sih Fung (AGENT) |
| Authorized Official Contact | 7028022011 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Zane Medical Group Llc 3455 W Craig Rd Ste C North Las Vegas NV 89032-5119 Ph: (702) 802-2011 | Zane Medical Group Llc 3455 W Craig Rd Ste C North Las Vegas NV 89032-5119 Ph: (702) 802-2011 |
| NPI Number | 1801495932 |
|---|---|
| Provider Enumeration Date | 10/20/2020 |
| Last Update Date | 09/01/2022 |
| Certification Date | 09/01/2022 |
| Medicare PECOS PAC ID | 0345642476 |
|---|---|
| Medicare Enrollment ID | O20210713001027 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801495932 | NPI | - | NPPES |
| 250000654 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Mariliza Ilagan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114316320 PECOS PAC ID: 1254636970 Enrollment ID: I20170616001406 |
| Provider Name | Nelson Jong Kwowi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689203853 PECOS PAC ID: 3577978527 Enrollment ID: I20210224002553 |
| Provider Name | Sharon Marjorie Tomlinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386267466 PECOS PAC ID: 1759794340 Enrollment ID: I20210616002127 |
| Provider Name | Long V Tran |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821691429 PECOS PAC ID: 3870998248 Enrollment ID: I20210823002987 |
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