Provider Demographics
NPI:1174503429
Name:COMPREHENSIVE MEDICAL CENTER
Entity Type:Organization
Organization Name:COMPREHENSIVE MEDICAL CENTER
Other - Org Name:PRO BONO HUMANI LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-526-5078
Mailing Address - Street 1:110 N BOULDER HWY
Mailing Address - Street 2:# 120-08
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015
Mailing Address - Country:US
Mailing Address - Phone:702-577-0543
Mailing Address - Fax:515-583-4374
Practice Address - Street 1:98 E LAKE MEAD PKWY
Practice Address - Street 2:# 301
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015
Practice Address - Country:US
Practice Address - Phone:702-577-0543
Practice Address - Fax:515-583-4374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0926207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018927Medicaid
NV002018927Medicaid
NVV102198Medicare PIN