Provider Demographics
NPI:1003277443
Name:MAI HEALTH AND BEAUTY CLINIC LLC
Entity Type:Organization
Organization Name:MAI HEALTH AND BEAUTY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:THI
Authorized Official - Last Name:MAI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:702-480-2044
Mailing Address - Street 1:6771 W CHARLESTON BLVD
Mailing Address - Street 2:STE. B
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-9015
Mailing Address - Country:US
Mailing Address - Phone:702-480-2044
Mailing Address - Fax:
Practice Address - Street 1:6771 W CHARLESTON BLVD
Practice Address - Street 2:STE. B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-9015
Practice Address - Country:US
Practice Address - Phone:702-480-2044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-13
Last Update Date:2016-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV207Q00000X, 208D00000X, 261QM1300X, 363LA2200X, 363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty