Provider Demographics
NPI:1598892432
Name:SKIN CHECK SUMMERLIN LLC
Entity Type:Organization
Organization Name:SKIN CHECK SUMMERLIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DEPARTMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUSSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-234-2311
Mailing Address - Street 1:6425 WESTWIND RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-3442
Mailing Address - Country:US
Mailing Address - Phone:702-234-2311
Mailing Address - Fax:702-579-3909
Practice Address - Street 1:9416 DEL WEBB BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-8314
Practice Address - Country:US
Practice Address - Phone:702-234-2311
Practice Address - Fax:702-579-3909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV100274Medicare ID - Type UnspecifiedNV MEDICARE GROUP ID