Provider Demographics
NPI:1710945092
Name:HENDERSON OB/GYN LLC
Entity Type:Organization
Organization Name:HENDERSON OB/GYN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ORLANDIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-568-6108
Mailing Address - Street 1:PO BOX 530124
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89053-0124
Mailing Address - Country:US
Mailing Address - Phone:702-568-6108
Mailing Address - Fax:702-568-8603
Practice Address - Street 1:98 E LAKE MEAD PKWY STE 307
Practice Address - Street 2:SUITE 307
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-6444
Practice Address - Country:US
Practice Address - Phone:702-568-6108
Practice Address - Fax:702-568-8603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV102341Medicare ID - Type UnspecifiedGROUP #