Provider Demographics
NPI:1659550614
Name:TEMPLAR CLINICS
Entity Type:Organization
Organization Name:TEMPLAR CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TEMPLAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-350-8080
Mailing Address - Street 1:PO BOX 230610
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89105-0610
Mailing Address - Country:US
Mailing Address - Phone:206-350-8080
Mailing Address - Fax:775-855-5853
Practice Address - Street 1:5590 SAN FLORENTINE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-3866
Practice Address - Country:US
Practice Address - Phone:206-350-8080
Practice Address - Fax:775-855-5853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2000103-4262083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVG03987Medicare UPIN