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47 W Owens Ave North Las Vegas NV 89030-6865 | |
| (702) 307-4635 | |
| (702) 307-4631 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 47 W Owens Ave, North Las Vegas, Nevada |
| Authorized Official Name and Position | Walter B Davis (CEO) |
| Authorized Official Contact | 7758886610 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3325 Research Way Carson City NV 89706-7913 Ph: (775) 888-6610 | 47 W Owens Ave North Las Vegas NV 89030-6865 Ph: (702) 307-4635 |
| NPI Number | 1134295058 |
|---|---|
| Provider Enumeration Date | 11/24/2006 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 7113835307 |
|---|---|
| Medicare Enrollment ID | O20100722000176 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134295058 | NPI | - | NPPES |
| DQ468A | Other | NV | MEDICARE ID - TYPE UNSPECIFIED |
| 1134295058 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Nevada) | Primary |
| Provider Name | Aubrey Eyre Bohne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073885810 PECOS PAC ID: 8729453634 Enrollment ID: I20230406001746 |
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