| Platinum Wound Care Specialist | |
|
9975 S Eastern Ave Ste 110 Las Vegas NV 89183-7950 | |
| (702) 659-5604 | |
| (702) 660-6186 |
| Full Name | Platinum Wound Care Specialist |
|---|---|
| Speciality | Family Medicine |
| Location | 9975 S Eastern Ave Ste 110, Las Vegas, Nevada |
| Authorized Official Name and Position | Craig Jorgenson (OWNER) |
| Authorized Official Contact | 7026595604 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Platinum Wound Care Specialist 9975 S Eastern Ave Ste 110 Las Vegas NV 89183-7950 Ph: (702) 659-5604 | Platinum Wound Care Specialist 9975 S Eastern Ave Ste 110 Las Vegas NV 89183-7950 Ph: (702) 659-5604 |
| NPI Number | 1174208763 |
|---|---|
| Provider Enumeration Date | 06/20/2023 |
| Last Update Date | 06/20/2023 |
| Medicare PECOS PAC ID | 1658718093 |
|---|---|
| Medicare Enrollment ID | O20240321001693 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174208763 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Gina Balgoyen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891206983 PECOS PAC ID: 9931466190 Enrollment ID: I20171127002401 |
| Provider Name | Brian Keith Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487114583 PECOS PAC ID: 7810221090 Enrollment ID: I20190621000022 |
| Provider Name | Jimmy Cruza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063079234 PECOS PAC ID: 9830527019 Enrollment ID: I20200323000562 |
| Provider Name | Jennifer Roux |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972129203 PECOS PAC ID: 5890101075 Enrollment ID: I20230223000753 |
| Provider Name | Scott A Wall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659083418 PECOS PAC ID: 2062878358 Enrollment ID: I20230511000225 |
| Provider Name | Khadija Bilali-azzat |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962114843 PECOS PAC ID: 7113379678 Enrollment ID: I20240119002813 |
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