Provider Demographics
NPI: | 1457382863 |
---|---|
Name: | JORGENSON & KOKA LLP |
Entity Type: | Organization |
Organization Name: | JORGENSON & KOKA LLP |
Other - Org Name: | ADVANCED URGENT CARE & NIGHLIGHT PEDIATRICS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | MANAGING MEMBER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CRAIG |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | JORGENSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 702-492-7208 |
Mailing Address - Street 1: | PO BOX 530010 |
Mailing Address - Street 2: | |
Mailing Address - City: | HENDERSON |
Mailing Address - State: | NV |
Mailing Address - Zip Code: | 89053-0010 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 702-492-7208 |
Mailing Address - Fax: | 702-616-0657 |
Practice Address - Street 1: | 9975 S EASTERN AVE |
Practice Address - Street 2: | SUITE 110 |
Practice Address - City: | LAS VEGAS |
Practice Address - State: | NV |
Practice Address - Zip Code: | 89183-7949 |
Practice Address - Country: | US |
Practice Address - Phone: | 702-361-2273 |
Practice Address - Fax: | 702-616-0657 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-07-05 |
Last Update Date: | 2016-10-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
111N00000X, 207R00000X, 208D00000X, 225100000X, 225200000X, 225700000X, 247100000X, 363AM0700X, 363L00000X | ||
NV | 1915 | 204D00000X, 208100000X |
NV | 1001 | 207Q00000X, 2083X0100X |
NV | 9529 | 2083T0002X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
No | 111N00000X | Chiropractic Providers | Chiropractor | Group - Multi-Specialty | |
No | 204D00000X | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 2083T0002X | Allopathic & Osteopathic Physicians | Preventive Medicine | Medical Toxicology | Group - Multi-Specialty |
No | 2083X0100X | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine | Group - Multi-Specialty |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
No | 225700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | Group - Multi-Specialty | |
No | 247100000X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Group - Multi-Specialty | |
No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NV | 100508145 | Medicaid | |
NV | 101737 | Medicare PIN | |
NV | V101737 | Medicare PIN | |
NV | 100508145 | Medicaid |