| Irene M. Bourgault Do Pc | |
|
3150 N Tenaya Way Ste 660 Las Vegas NV 89128-0460 | |
| (702) 648-6228 | |
| (702) 648-9868 |
| Full Name | Irene M. Bourgault Do Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 3150 N Tenaya Way Ste 660, Las Vegas, Nevada |
| Authorized Official Name and Position | Irene Mary Bourgault (OWNER) |
| Authorized Official Contact | 7026486228 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Irene M. Bourgault Do Pc 3150 N Tenaya Way Ste 660 Las Vegas NV 89128-0460 Ph: (702) 648-6228 | Irene M. Bourgault Do Pc 3150 N Tenaya Way Ste 660 Las Vegas NV 89128-0460 Ph: (702) 648-6228 |
| NPI Number | 1255511739 |
|---|---|
| Provider Enumeration Date | 11/13/2007 |
| Last Update Date | 12/18/2007 |
| Medicare PECOS PAC ID | 0446220560 |
|---|---|
| Medicare Enrollment ID | O20040727001373 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255511739 | NPI | - | NPPES |
| V32710 | Other | NV | MEDICARE |
| V32709 | Other | NV | MEDICARE GROUP |
| V39744 | Other | NV | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 350 (Nevada) | Primary |
| Provider Name | Stephanie C Casalman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740364918 PECOS PAC ID: 8921900184 Enrollment ID: I20040814000252 |
| Provider Name | Irene M Bourgault |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164562120 PECOS PAC ID: 8820026032 Enrollment ID: I20110107000329 |
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