Provider Demographics
NPI:1346306438
Name:CLEMENT J. STRUMILLO, D.O., APC
Entity Type:Organization
Organization Name:CLEMENT J. STRUMILLO, D.O., APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLEMENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:STRUMILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-315-4600
Mailing Address - Street 1:2685 S RAINBOW BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5182
Mailing Address - Country:US
Mailing Address - Phone:702-315-4600
Mailing Address - Fax:702-315-4607
Practice Address - Street 1:2685 S RAINBOW BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5182
Practice Address - Country:US
Practice Address - Phone:702-315-4600
Practice Address - Fax:702-315-4607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-31
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2019399Medicaid
V37851OtherMEDICARE GROUP/ORGANIZATIONAL #
V37851OtherMEDICARE GROUP/ORGANIZATIONAL #
E69594Medicare UPIN