Provider Demographics
NPI:1659471431
Name:MISCH/HYUN/HODAPP HEALTHCARE, LLP
Entity Type:Organization
Organization Name:MISCH/HYUN/HODAPP HEALTHCARE, LLP
Other - Org Name:ST. ROSE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:MISCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-564-8556
Mailing Address - Street 1:2350 W HORIZON RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5075
Mailing Address - Country:US
Mailing Address - Phone:702-564-8556
Mailing Address - Fax:702-564-4485
Practice Address - Street 1:2350 W HORIZON RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5075
Practice Address - Country:US
Practice Address - Phone:702-564-8556
Practice Address - Fax:702-564-4485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty