Provider Demographics
NPI:1265681589
Name:MMCS LLC KATHRYN GELO SOLE MBR
Entity Type:Organization
Organization Name:MMCS LLC KATHRYN GELO SOLE MBR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GELO
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:702-497-9706
Mailing Address - Street 1:PO BOX 34171
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-4171
Mailing Address - Country:US
Mailing Address - Phone:702-497-9706
Mailing Address - Fax:702-965-2544
Practice Address - Street 1:10401 CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-1151
Practice Address - Country:US
Practice Address - Phone:702-497-9706
Practice Address - Fax:702-965-2544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN00362363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVAS174Medicare PIN