Provider Demographics
NPI:1629362959
Name:TOTAL FAMILY CARE SPECIALISTS
Entity Type:Organization
Organization Name:TOTAL FAMILY CARE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MADLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLYIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-233-4555
Mailing Address - Street 1:3280 N RAINBOW BLVD
Mailing Address - Street 2:110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-5011
Mailing Address - Country:US
Mailing Address - Phone:702-233-4555
Mailing Address - Fax:702-233-1081
Practice Address - Street 1:3280 N RAINBOW BLVD
Practice Address - Street 2:110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108
Practice Address - Country:US
Practice Address - Phone:702-233-4555
Practice Address - Fax:702-233-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-03
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2019551Medicaid
NVE95681OtherUPIN
NVE95681OtherUPIN