| National Retail Llc | |
|
4260 Cameron St Ste A Las Vegas NV 89103-3718 | |
| (702) 853-5055 | |
| Not Available |
| Full Name | National Retail Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 4260 Cameron St Ste A, Las Vegas, Nevada |
| Authorized Official Name and Position | Adin Boldur (MEDICAL DIRECTOR) |
| Authorized Official Contact | 7028535055 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| National Retail Llc 4260 Cameron St Ste A Las Vegas NV 89103-3718 Ph: () - | National Retail Llc 4260 Cameron St Ste A Las Vegas NV 89103-3718 Ph: (702) 853-5055 |
| NPI Number | 1104544220 |
|---|---|
| Provider Enumeration Date | 08/15/2022 |
| Last Update Date | 08/16/2022 |
| Medicare PECOS PAC ID | 7719361765 |
|---|---|
| Medicare Enrollment ID | O20221002000049 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104544220 | NPI | - | NPPES |
| NV20131357533 | Other | NV | SECRETARY OF STATE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Adin Boldur |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1619914066 PECOS PAC ID: 4183515844 Enrollment ID: I20060419000119 |
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