Provider Demographics
NPI:1811416530
Name:CIDS FAMILY PRACTICE
Entity type:Organization
Organization Name:CIDS FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING & CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCALISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:725-200-3232
Mailing Address - Street 1:2435 FIRE MESA ST STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-9009
Mailing Address - Country:US
Mailing Address - Phone:702-968-2437
Mailing Address - Fax:
Practice Address - Street 1:2435 FIRE MESA ST STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-9009
Practice Address - Country:US
Practice Address - Phone:725-200-3242
Practice Address - Fax:725-200-3244
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DHAVAL SHAH MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-13
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty