| David Vansomphone Md Ltd | |
|
5375 S Fort Apache Rd Suite 101 Las Vegas NV 89148-7623 | |
| (702) 597-1597 | |
| Not Available |
| Full Name | David Vansomphone Md Ltd |
|---|---|
| Speciality | Internal Medicine |
| Location | 5375 S Fort Apache Rd, Las Vegas, Nevada |
| Authorized Official Name and Position | Lori Labrecque (ACCTS. MGR) |
| Authorized Official Contact | 7024533799 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| David Vansomphone Md Ltd Po Box 35984 Las Vegas NV 89133-5984 Ph: (702) 597-1597 | David Vansomphone Md Ltd 5375 S Fort Apache Rd Suite 101 Las Vegas NV 89148-7623 Ph: (702) 597-1597 |
| NPI Number | 1750598165 |
|---|---|
| Provider Enumeration Date | 05/16/2007 |
| Last Update Date | 05/17/2010 |
| Medicare PECOS PAC ID | 0648233650 |
|---|---|
| Medicare Enrollment ID | O20110419000752 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750598165 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 9448 (Nevada) | Primary |
| Provider Name | Boungkhong David Vansomphone |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457451262 PECOS PAC ID: 5991768905 Enrollment ID: I20041111000179 |
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