| Jateko Family Medical Group | |
|
3860 W Ann Rd N Las Vegas NV 89031-4409 | |
| (702) 474-4110 | |
| Not Available |
| Full Name | Jateko Family Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 3860 W Ann Rd, N Las Vegas, Nevada |
| Authorized Official Name and Position | Jeaniene A Talley (PRESIDENT) |
| Authorized Official Contact | 7024744110 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jateko Family Medical Group Po Box 92001 Las Vegas NV 89193-2001 Ph: (702) 218-0268 | Jateko Family Medical Group 3860 W Ann Rd N Las Vegas NV 89031-4409 Ph: (702) 474-4110 |
| NPI Number | 1356528103 |
|---|---|
| Provider Enumeration Date | 01/23/2008 |
| Last Update Date | 08/02/2021 |
| Medicare PECOS PAC ID | 8123102373 |
|---|---|
| Medicare Enrollment ID | O20080226000692 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356528103 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 10389 (Nevada) | Primary |
| Provider Name | Jeaniene A Talley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003889585 PECOS PAC ID: 5698768729 Enrollment ID: I20040406000619 |
| Provider Name | Nicole Marie Fetto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639783210 PECOS PAC ID: 9234549577 Enrollment ID: I20201028000395 |
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