| Southern Nevada Internal Medicine Pediatrics | |
|
6252 S Rainbow Blvd Suite 110 Las Vegas NV 89118-3248 | |
| (702) 253-5410 | |
| (702) 433-5410 |
| Full Name | Southern Nevada Internal Medicine Pediatrics |
|---|---|
| Speciality | Internal Medicine |
| Location | 6252 S Rainbow Blvd, Las Vegas, Nevada |
| Authorized Official Name and Position | Constantine George (OWNER) |
| Authorized Official Contact | 7022535410 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Nevada Internal Medicine Pediatrics 2725 S Jones Blvd Suite 100 Las Vegas NV 89146-5605 Ph: (702) 253-5410 | Southern Nevada Internal Medicine Pediatrics 6252 S Rainbow Blvd Suite 110 Las Vegas NV 89118-3248 Ph: (702) 253-5410 |
| NPI Number | 1255452785 |
|---|---|
| Provider Enumeration Date | 04/03/2007 |
| Last Update Date | 09/03/2010 |
| Medicare PECOS PAC ID | 4789613522 |
|---|---|
| Medicare Enrollment ID | O20050811000527 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255452785 | NPI | - | NPPES |
| 100506950 | Medicaid | NV | |
| 100508862 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 11122 (Nevada) | Primary |
| 208000000X | Pediatrics | 11122 (Nevada) | Secondary |
| Provider Name | Constantine George |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164429858 PECOS PAC ID: 6305875147 Enrollment ID: I20050811000566 |
| Provider Name | Travis G Hailstone |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215165238 PECOS PAC ID: 0840448999 Enrollment ID: I20120913000684 |
| Provider Name | Treveris Begalman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316577885 PECOS PAC ID: 6507259801 Enrollment ID: I20220209002040 |
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