Provider Demographics
NPI:1619126257
Name:DIAGNOSTIC CENTER OF MEDICINE (ALLEN) LLP
Entity Type:Organization
Organization Name:DIAGNOSTIC CENTER OF MEDICINE (ALLEN) LLP
Other - Org Name:DIAGNOSTIC CENTER OF MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-366-0640
Mailing Address - Street 1:3012 S DURANGO DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-9186
Mailing Address - Country:US
Mailing Address - Phone:702-366-1655
Mailing Address - Fax:702-942-4388
Practice Address - Street 1:6301 MOUNTAIN VISTA STREET
Practice Address - Street 2:SUITE 108
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014
Practice Address - Country:US
Practice Address - Phone:702-454-1322
Practice Address - Fax:702-454-1624
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIAGNOSTIC CENTER OF MEDICINE (ALLEN) LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-18
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100501975Medicaid
NV100501975Medicaid