Provider Demographics
NPI:1164156790
Name:HUMMINGBIRD MEDICAL GROUP
Entity Type:Organization
Organization Name:HUMMINGBIRD MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ENSING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-745-4091
Mailing Address - Street 1:5550 PAINTED MIRAGE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4581
Mailing Address - Country:US
Mailing Address - Phone:725-204-1474
Mailing Address - Fax:725-500-5049
Practice Address - Street 1:5550 PAINTED MIRAGE RD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4581
Practice Address - Country:US
Practice Address - Phone:725-204-1474
Practice Address - Fax:725-500-5049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-11
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty