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1477 E Lake Mead Parkway Ste 130 Henderson NV 89011 | |
(702) 849-9092 | |
(702) 446-8189 |
Full Name | |
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Speciality | General Practice |
Location | 1477 E Lake Mead Parkway, Henderson, Nevada |
Authorized Official Name and Position | Michael Kane (OWNER) |
Authorized Official Contact | 2013701133 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 36777 Las Vegas NV 89133-6777 Ph: () - | 1477 E Lake Mead Parkway Ste 130 Henderson NV 89011 Ph: (702) 849-9092 |
NPI Number | 1518659663 |
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Provider Enumeration Date | 05/25/2023 |
Last Update Date | 12/08/2023 |
Medicare PECOS PAC ID | 6002253366 |
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Medicare Enrollment ID | O20240321003059 |
Identifier | Type | State | Issuer |
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1518659663 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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208D00000X | General Practice | (* (Not Available)) | Primary |
Provider Name | Michael R Kane |
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Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1952477762 PECOS PAC ID: 8628095973 Enrollment ID: I20220517000893 |
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