Provider Demographics
NPI:1487665667
Name:FAYLONA GOLLARD KAUSHAL NYAMUSWA & PARK LTD
Entity Type:Organization
Organization Name:FAYLONA GOLLARD KAUSHAL NYAMUSWA & PARK LTD
Other - Org Name:CANCER & BLOOD SPECIALISTS OF NEVADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-822-2000
Mailing Address - Street 1:2460 W HORIZON RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2736
Mailing Address - Country:US
Mailing Address - Phone:702-822-2000
Mailing Address - Fax:702-938-2237
Practice Address - Street 1:2020 SILVER CREEK RD
Practice Address - Street 2:BLDG A #103
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442
Practice Address - Country:US
Practice Address - Phone:928-758-0135
Practice Address - Fax:928-758-0175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ21168Medicare PIN
AZ1283140003Medicare NSC