Provider Demographics
NPI:1659492379
Name:MESQUITE WOMENS CLINIC LLC
Entity Type:Organization
Organization Name:MESQUITE WOMENS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:OFORI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-345-2122
Mailing Address - Street 1:1301 BERTHA HOWE AVE
Mailing Address - Street 2:#2
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89027-7502
Mailing Address - Country:US
Mailing Address - Phone:702-345-2122
Mailing Address - Fax:702-345-3063
Practice Address - Street 1:1301 BERTHA HOWE AVE
Practice Address - Street 2:#2
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-7502
Practice Address - Country:US
Practice Address - Phone:702-345-2122
Practice Address - Fax:702-345-3063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1175207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100504922Medicaid