Provider Demographics
NPI:1629079884
Name:BERNARD ADDO-QUAYE MD PC
Entity Type:Organization
Organization Name:BERNARD ADDO-QUAYE MD PC
Other - Org Name:TRUCARE MEDICAL INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:K
Authorized Official - Last Name:ADDO-QUAYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-657-6365
Mailing Address - Street 1:2290 MCDANIEL ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-6330
Mailing Address - Country:US
Mailing Address - Phone:702-657-6365
Mailing Address - Fax:702-657-6704
Practice Address - Street 1:1721 E CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-1902
Practice Address - Country:US
Practice Address - Phone:702-685-0620
Practice Address - Fax:702-685-9674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9413207Q00000X
207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100505937Medicaid
NV100505937Medicaid