Provider Demographics
NPI:1033384896
Name:KID DOCTORS URGENT CARE
Entity Type:Organization
Organization Name:KID DOCTORS URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:DEURELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-450-5437
Mailing Address - Street 1:4840 S FORT APACHE ROAD
Mailing Address - Street 2:101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-7949
Mailing Address - Country:US
Mailing Address - Phone:702-254-5437
Mailing Address - Fax:702-367-1698
Practice Address - Street 1:4840 S FORT APACHE
Practice Address - Street 2:101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-7949
Practice Address - Country:US
Practice Address - Phone:702-254-5437
Practice Address - Fax:702-367-1698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2081207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506923Medicaid