Provider Demographics
NPI:1518916451
Name:CHILDRENS LUNG SPECIALISTS
Entity Type:Organization
Organization Name:CHILDRENS LUNG SPECIALISTS
Other - Org Name:CHILDRENS LUNG SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:T
Authorized Official - Last Name:NAKAMURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-598-4411
Mailing Address - Street 1:3196 S MARYLAND PKWY STE 209
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2313
Mailing Address - Country:US
Mailing Address - Phone:702-598-4411
Mailing Address - Fax:702-598-1988
Practice Address - Street 1:3196 S MARYLAND PKWY STE 209
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2313
Practice Address - Country:US
Practice Address - Phone:702-598-4411
Practice Address - Fax:702-598-1988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV95722080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100511761Medicaid
NV002018313Medicaid
NV0020-18611Medicaid
NV0020-18611Medicaid
NVH32485Medicare UPIN
NV34583Medicare ID - Type Unspecified
NV100511761Medicaid
NV100112Medicare PIN