Provider Demographics
NPI:1922201896
Name:ROBERT W SHRECK MD LTD
Entity Type:Organization
Organization Name:ROBERT W SHRECK MD LTD
Other - Org Name:SHRECK FAMILY HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHRECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-733-8803
Mailing Address - Street 1:2505 ANTHEM VILLAGE DR
Mailing Address - Street 2:SUITE E-334
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5505
Mailing Address - Country:US
Mailing Address - Phone:702-733-8803
Mailing Address - Fax:702-733-7488
Practice Address - Street 1:3048 PALATINE TERRACE DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3002
Practice Address - Country:US
Practice Address - Phone:702-733-8803
Practice Address - Fax:702-733-7488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3373261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1962436824Medicare ID - Type UnspecifiedPROVIDER NPI NUMBER
NVV31292Medicare PIN
NVC96565Medicare UPIN