# LAS VEGAS KIDNEY CLINIC INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245234145
- **Authorized official:** MR. GALEN ROBERT BENNETT BSBA (ADMINISTRATOR)
- **Authorized official phone:** (702) 214-9516

## Contact information

- **Practice address:** 1905 CIVIC CENTER DR, STE 201, NORTH LAS VEGAS, NV 89030-7116
- **Practice address phone:** (702) 214-9516
- **Practice address fax:** (702) 214-9415
- **Mailing address:** 1905 CIVIC CENTER DR, STE 201, NORTH LAS VEGAS, NV 89030-7116
- **Mailing address phone:** (702) 214-9516
- **Mailing address fax:** (702) 214-9415

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 3221ESR3 | NV | Yes |

## Other

- **Enumeration date:** 06/08/2005
- **Last updated:** 06/06/2008