Provider Demographics
NPI:1578584678
Name:ELLIS BANDT BIRKIN KOLLINS & WONG PLLC
Entity Type:Organization
Organization Name:ELLIS BANDT BIRKIN KOLLINS & WONG PLLC
Other - Org Name:DESERT RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-218-9368
Mailing Address - Street 1:2020 PALOMINO LN STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4894
Mailing Address - Country:US
Mailing Address - Phone:702-759-8778
Mailing Address - Fax:702-384-1815
Practice Address - Street 1:2020 PALOMINO LN
Practice Address - Street 2:STE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4894
Practice Address - Country:US
Practice Address - Phone:702-759-8778
Practice Address - Fax:702-384-1815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADU4981OtherRR MEDICARE DR
NV1578584678Medicaid
OK200467490AMedicaid
CACA110973Medicare PIN
CAFM199BMedicare PIN
MIMI7315Medicare PIN
ORR161766Medicare PIN
AZZ177274Medicare PIN
CO334613Medicare PIN
CAFM199AMedicare PIN
DC170407Medicare PIN
CACB219564Medicare PIN
OK200467490AMedicaid
NVV50476Medicare PIN
GA202G701653Medicare PIN
CADU4981OtherRR MEDICARE DR
NC2347945Medicare PIN
NM338014Medicare PIN
FLID562AMedicare PIN
KSKA3115Medicare PIN