Provider Demographics
NPI:1477026243
Name:GOLAN INTEGRATED PHYSICAL MEDICINE
Entity Type:Organization
Organization Name:GOLAN INTEGRATED PHYSICAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-263-4925
Mailing Address - Street 1:PO BOX 561564
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256-1564
Mailing Address - Country:US
Mailing Address - Phone:702-202-1850
Mailing Address - Fax:
Practice Address - Street 1:321 N PECOS RD STE 200
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-1348
Practice Address - Country:US
Practice Address - Phone:702-263-4925
Practice Address - Fax:702-263-6874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-04
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation