Provider Demographics
NPI:1518189745
Name:ANTHONY L POLLARD DO A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ANTHONY L POLLARD DO A PROFESSIONAL CORPORATION
Other - Org Name:RAINBOW MEDICAL CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:DALZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-255-9300
Mailing Address - Street 1:1331 S RAINBOW BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-9238
Mailing Address - Country:US
Mailing Address - Phone:702-255-9300
Mailing Address - Fax:702-255-0846
Practice Address - Street 1:1341 S RAINBOW BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-9069
Practice Address - Country:US
Practice Address - Phone:702-255-4200
Practice Address - Fax:702-255-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV30375Medicare PIN