Provider Demographics
NPI:1821264482
Name:ENSIGN FAMILY MEDICINE
Entity Type:Organization
Organization Name:ENSIGN FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SANFORD
Authorized Official - Middle Name:F
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-951-3400
Mailing Address - Street 1:5771 S FORT APACHE RD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5626
Mailing Address - Country:US
Mailing Address - Phone:702-951-3400
Mailing Address - Fax:702-951-3403
Practice Address - Street 1:5771 S FORT APACHE RD
Practice Address - Street 2:SUITE #100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5626
Practice Address - Country:US
Practice Address - Phone:702-951-3400
Practice Address - Fax:702-951-3403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018784Medicaid
V36828Medicare PIN
NV002018784Medicaid