Provider Demographics
NPI:1629383526
Name:CARLSON MED GROUP
Entity Type:Organization
Organization Name:CARLSON MED GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-418-6334
Mailing Address - Street 1:2245 N GREEN VALLEY PKWY
Mailing Address - Street 2:SUITE 566
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-5024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2245 N GREEN VALLEY PKWY
Practice Address - Street 2:SUITE 566
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-5024
Practice Address - Country:US
Practice Address - Phone:702-418-6334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty