Provider Demographics
NPI:1922008523
Name:RUCKDESCHEL MANNO, LTD. DBA
Entity Type:Organization
Organization Name:RUCKDESCHEL MANNO, LTD. DBA
Other - Org Name:NEVADA CANCER INSTITUTE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-822-5433
Mailing Address - Street 1:PO BOX 98809
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8809
Mailing Address - Country:US
Mailing Address - Phone:702-822-5433
Mailing Address - Fax:702-944-0471
Practice Address - Street 1:ONE BREAKTHROUGH WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-3011
Practice Address - Country:US
Practice Address - Phone:702-822-5433
Practice Address - Fax:702-944-0471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
No261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506879Medicaid
NVV100505Medicare PIN