Organization
LAS VEGAS KIDNEY CLINIC INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GALEN ROBERT BENNETT BSBA (ADMINISTRATOR)
(702) 214-9516
Entity
Organization
Contact information
Practice address
1905 CIVIC CENTER DR, STE 201, NORTH LAS VEGAS, NV 89030-7116
(702) 214-9516
(702) 214-9415
Mailing address
1905 CIVIC CENTER DR, STE 201, NORTH LAS VEGAS, NV 89030-7116
(702) 214-9516
(702) 214-9415
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
3221ESR3
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100501915
—
NV
Enumeration date
06/08/2005
Last updated
06/06/2008
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