FREMONT PRIMARY CARE - ENDOCRINOLOGY (NPI# 1295712693) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295712693 |
| Entity Type | Organization |
| Organization Name | FREMONT PRIMARY CARE - ENDOCRINOLOGY |
| Other Organization Name | JOSLIN DIABETES CENTER AFFILIATE AT FREMONT MEDICAL CENTER |
| Practice Address |
4880 Wynn Rd Las Vegas NV 89103-5406 |
| Mailing Address |
Po Box 1737 Las Vegas NV 89125-1737 |
| Practice Telephone | 7023623422 |
| Practice Fax Number | 7029398827 |
| Mailing Telephone | 7026716800 |
| Mailing Fax Number | 7026716855 |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | JON GREG GRIFFIN (CEO) |
| Authorized Official Telephone | 7026716800 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 133VN1006X |
Dietitian, Registered Specialization: Nutrition, Metabolic |
Dietary & Nutritional Service Providers | ||
| X | 133V00000X | Dietitian, Registered | Dietary & Nutritional Service Providers | ||
| X | 207RE0101X |
Internal Medicine Specialization: Endocrinology, Diabetes & Metabolism |
Allopathic & Osteopathic Physicians | ||
| X | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers |
| Other Name | Type Code |
|---|---|
| Joslin Diabetes Center Affiliate at Fremont Medical Center | Other Name - Individual/Organization |
| Street Address |
4880 WYNN RD |
| City | LAS VEGAS |
| State | NV |
| Zip Code | 89103-5406 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306849328 | Irfan Tahir | Internal Medicine | 4880 Wynn Rd, Las Vegas, NV 89103-5406 | 2005-05-23 |
| 1699146464 | Ike Michael Ekekwe | Nurse Practitioner | 4880 Wynn Rd, Las Vegas, NV 89103-5406 | 2015-10-19 |
| 1376910273 | Cody L Pulsipher | Physician Assistant | 4880 Wynn Rd, Las Vegas, NV 89103-5406 | 2015-08-26 |
| 1669747564 | Zima Pakzad | Family Medicine | 4880 Wynn Rd, Las Vegas, NV 89103-5406 | 2012-03-12 |
| 1336428853 | Laurel A Kleinman | Nurse Practitioner | 4880 Wynn Rd, Las Vegas, NV 89103 | 2011-08-15 |
| 1659664191 | Ricky Walker Jr. | Family Medicine | 4880 Wynn Rd, Urgent Care, Las Vegas, NV 89103-5406 | 2011-05-17 |
| 1518261544 | J. Corey Brown, Pllc | General Practice | 4880 Wynn Rd, Las Vegas, NV 89103-5406 | 2011-01-05 |
| 1710205257 | Judy Hui-ling Chen | Nurse Practitioner | 4880 Wynn Rd, Las Vegas, NV 89103-5406 | 2010-05-07 |
| 1689906703 | Diane M Levin | Family Medicine | 4880 Wynn Rd, Las Vegas, NV 89103-5406 | 2010-02-01 |
| 1821247206 | Kittusamy LLP | Internal Medicine | 4880 Wynn Rd, Suite 100, Las Vegas, NV 89103-5406 | 2008-09-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043821671 | New Directions LLC | Counselor | 3651 S Lindell Dr, Ste D15 B, Las Vegas, NV 89103 | 2020-08-17 |
| 1396356929 | A-plus Community Counseling Services LLC | Counselor | 3651 S Lindell Dr Ste D15, Las Vegas, NV 89103 | 2020-08-17 |
| 1437798931 | Las Vegas Diagnostic & Treatment LLC | Neuromusculoskeletal Medicine & OMM | Dpm, 5650 W Flamingo Rd Ste A, Las Vegas, NV 89103 | 2019-12-31 |
| 1033769385 | Maria Yemi Centeno | Technician | 4674 Via Torino, Las Vegas, NV 89103 | 2019-09-18 |
| 1750847869 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 3821 W Flamingo Rd, Las Vegas, NV 89103 | 2019-02-13 |
| 1447741905 | Adgold Medical Corp | Durable Medical Equipment & Medical Supplies | 3651 Lindell Rd Ste D536, Las Vegas, NV 89103 | 2018-05-21 |
| 1184138620 | Kiley Ballew | Social Worker | 4425 South Jones, Suite D3, Las Vegas, NV 89103 | 2017-11-20 |
| 1396275988 | Karen Walton | Technician | 5419 W. Tropicana Ave. A2803, Las Vegas, NV 89103 | 2017-06-15 |
| 1760923643 | Shannon-dorothy Austria | Social Worker | 4425 S. Jones, Suite D3, Las Vegas, NV 89103 | 2017-03-13 |
| 1306260583 | Ladonna Smith | Behavioral Analyst | 1126 Tamerck Ave, Las Vegas, NV 89103 | 2014-02-10 |
| Find all providers in zip 89103 | ||||
| Taxonomy Code | 133VN1006X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Dietitian, Registered |
| Specialization | Nutrition, Metabolic |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255527925 | Kim Belinda Mason | Dietitian, Registered | 42 Summit St, Virginia City, NV 89440 | 2007-09-17 |
| 1700069788 | Laura Ann Deverse | Dietitian, Registered | 1600 Medical Pkwy, Nutritional Services, Carson City, NV 89703-4625 | 2007-12-12 |
| 1487672333 | Renie Louise Tharp | Dietitian, Registered | 1779 Lantana Dr, Minden, NV 89423-5172 | 2006-07-18 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.