Provider Demographics
NPI:1598776783
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: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:
Authorized Official - Phone:702-822-2000
Mailing Address - Street 1:58 N PECOS RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7319
Mailing Address - Country:US
Mailing Address - Phone:702-822-2000
Mailing Address - Fax:702-938-2238
Practice Address - Street 1:6190 S FORT APACHE RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-6702
Practice Address - Country:US
Practice Address - Phone:702-822-2000
Practice Address - Fax:702-938-2238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1283140004Medicare NSC