Provider Demographics
NPI:1043556905
Name:WELLHEALTH MEDICAL GROUP (VOLKER), PC
Entity Type:Organization
Organization Name:WELLHEALTH MEDICAL GROUP (VOLKER), PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:VOLKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-682-8893
Mailing Address - Street 1:10100 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-5003
Mailing Address - Country:US
Mailing Address - Phone:702-545-6116
Mailing Address - Fax:702-921-2419
Practice Address - Street 1:10100 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-5003
Practice Address - Country:US
Practice Address - Phone:702-545-6116
Practice Address - Fax:702-921-2419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-21
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20121468781207L00000X, 207V00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty