Organization
ESSENTIAL MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VICKIE PENCE MS,PAC (DIRECTOR)
(602) 881-8888
Entity
Organization
Contact information
Practice address
1485 E FLAMINGO RD, LAS VEGAS, NV 89119-5256
(702) 734-8600
Mailing address
1485 E FLAMINGO RD, LAS VEGAS, NV 89119-5256
(702) 734-8600
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
7546NV
NV
363AM0700X
Medical Physician Assistant
965
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100510737
—
NV
01
—
1083791313
NPI
—
01
—
1336199363
NPI
NV
01
—
I65290
UPIN
NV
Enumeration date
12/02/2009
Last updated
12/02/2009
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