| Glc Wellness Center Llc | |
|
916 W Owens Ave Las Vegas NV 89106-2516 | |
| (877) 767-1692 | |
| Not Available |
| Full Name | Glc Wellness Center Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 916 W Owens Ave, Las Vegas, Nevada |
| Authorized Official Name and Position | Nancy Griffin (OWNER) |
| Authorized Official Contact | 8777671692 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Glc Wellness Center Llc Po Box 3543 Oak Brook IL 60522-3543 Ph: () - | Glc Wellness Center Llc 916 W Owens Ave Las Vegas NV 89106-2516 Ph: (877) 767-1692 |
| NPI Number | 1225622889 |
|---|---|
| Provider Enumeration Date | 02/24/2021 |
| Last Update Date | 02/24/2021 |
| Medicare PECOS PAC ID | 3476942335 |
|---|---|
| Medicare Enrollment ID | O20211115001558 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225622889 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Robert H Ingham |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1851358410 PECOS PAC ID: 0244292415 Enrollment ID: I20041117000500 |
| Provider Name | Maxine B Ingham |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730294455 PECOS PAC ID: 8325014541 Enrollment ID: I20101028000939 |
| Provider Name | Dithra Ann Cotton-lewis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487159182 PECOS PAC ID: 0749539161 Enrollment ID: I20180817002985 |
| Provider Name | Lisa M Gorman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619536844 PECOS PAC ID: 7214261973 Enrollment ID: I20190628002678 |
| Provider Name | Onyx Michele Reed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932741048 PECOS PAC ID: 4082042015 Enrollment ID: I20200325000822 |
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