Provider Demographics
NPI:1942371422
Name:CYRIAC K CHEMPLAVIL MD PC
Entity Type:Organization
Organization Name:CYRIAC K CHEMPLAVIL MD PC
Other - Org Name:CK CHEMPLAVIL MD PC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:TALBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-735-4094
Mailing Address - Street 1:8965 S PECOS RD STE 11A
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7159
Mailing Address - Country:US
Mailing Address - Phone:702-735-4094
Mailing Address - Fax:702-735-1994
Practice Address - Street 1:8965 S PECOS RD STE 11A
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7159
Practice Address - Country:US
Practice Address - Phone:702-735-4094
Practice Address - Fax:702-735-1994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4180174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVVMD4180Medicare ID - Type Unspecified
NVC95877Medicare UPIN