Provider Demographics
NPI:1740381243
Name:KELLER WELLS AND ASSOCIATES PC
Entity Type:Organization
Organization Name:KELLER WELLS AND ASSOCIATES PC
Other - Org Name:HENDERSON OBGYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
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 1:129 W LAKE MEAD PKWY STE 19
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7055
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:2006-09-26
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100509523Medicaid
NVV102925Medicare PIN