Provider Demographics
NPI:1811194533
Name:NEVADA TENDONITIS CLINIC LLC
Entity Type:Organization
Organization Name:NEVADA TENDONITIS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANDELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-617-2995
Mailing Address - Street 1:2225 VILLAGE WALK DR
Mailing Address - Street 2:SUITE 280
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5679
Mailing Address - Country:US
Mailing Address - Phone:702-617-2995
Mailing Address - Fax:
Practice Address - Street 1:2225 VILLAGE WALK DR
Practice Address - Street 2:SUITE 280
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5679
Practice Address - Country:US
Practice Address - Phone:702-617-2995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV101359Medicare PIN