Provider Demographics
NPI:1669852042
Name:MAI FAMILY HEALTH CLINIC LLC
Entity Type:Organization
Organization Name:MAI FAMILY HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSE THI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAI
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:702-480-2044
Mailing Address - Street 1:9315 W SUNSET RD
Mailing Address - Street 2:100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5011
Mailing Address - Country:US
Mailing Address - Phone:702-480-2044
Mailing Address - Fax:702-638-7706
Practice Address - Street 1:9315 W SUNSET RD
Practice Address - Street 2:100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5011
Practice Address - Country:US
Practice Address - Phone:702-480-2044
Practice Address - Fax:702-638-7706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty