Provider Demographics
NPI:1922043900
Name:DIAGNOSTIC CENTER OF MEDICINE (ALLEN) LLP
Entity Type:Organization
Organization Name:DIAGNOSTIC CENTER OF MEDICINE (ALLEN) LLP
Other - Org Name:DIAGNOSTIC CENTER OF MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MISKECH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-366-0640
Mailing Address - Street 1:5915 S RAINBOW BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-2558
Mailing Address - Country:US
Mailing Address - Phone:702-366-0640
Mailing Address - Fax:702-366-9672
Practice Address - Street 1:5915 S RAINBOW BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2558
Practice Address - Country:US
Practice Address - Phone:702-366-0640
Practice Address - Fax:702-366-9672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100501975Medicaid
NVV38808Medicare PIN