| Canyon Trails Family Practice & Sports Medicine | |
|
7455 W Washington Ave Suite 445 Las Vegas NV 89128-4337 | |
| (702) 804-5138 | |
| (702) 804-5364 |
| Full Name | Canyon Trails Family Practice & Sports Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 7455 W Washington Ave, Las Vegas, Nevada |
| Authorized Official Name and Position | Michael J Gunter (PRESIDENT) |
| Authorized Official Contact | 7022287117 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Canyon Trails Family Practice & Sports Medicine 7455 W Washington Ave Suite 445 Las Vegas NV 89128-4337 Ph: (702) 804-5138 | Canyon Trails Family Practice & Sports Medicine 7455 W Washington Ave Suite 445 Las Vegas NV 89128-4337 Ph: (702) 804-5138 |
| NPI Number | 1548398647 |
|---|---|
| Provider Enumeration Date | 03/01/2007 |
| Last Update Date | 02/01/2011 |
| Medicare PECOS PAC ID | 7719905678 |
|---|---|
| Medicare Enrollment ID | O20051109000429 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548398647 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | 8113 (Nevada) | Primary |
| Provider Name | Michael J Gunter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558319822 PECOS PAC ID: 1557389426 Enrollment ID: I20111214000560 |
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