| St Rose Integrated Medical Center | |
|
10561 Jeffreys St Ste 100 Henderson NV 89052-4267 | |
| (702) 405-6333 | |
| Not Available |
| Full Name | St Rose Integrated Medical Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 10561 Jeffreys St Ste 100, Henderson, Nevada |
| Authorized Official Name and Position | Yvonne C Ortega (CEO) |
| Authorized Official Contact | 7024056333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St Rose Integrated Medical Center 10561 Jeffreys St Ste 100 Henderson NV 89052-4267 Ph: (702) 405-6333 | St Rose Integrated Medical Center 10561 Jeffreys St Ste 100 Henderson NV 89052-4267 Ph: (702) 405-6333 |
| NPI Number | 1033678933 |
|---|---|
| Provider Enumeration Date | 03/19/2019 |
| Last Update Date | 07/23/2020 |
| Medicare PECOS PAC ID | 5890020861 |
|---|---|
| Medicare Enrollment ID | O20190712001326 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033678933 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Yvonne C Ortega |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1831185453 PECOS PAC ID: 6002869609 Enrollment ID: I20070119000016 |
| Provider Name | Hugh A Burt |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972599371 PECOS PAC ID: 1951392794 Enrollment ID: I20101123000380 |
| Provider Name | Brian D Bishop |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568532752 PECOS PAC ID: 8820272602 Enrollment ID: I20110404000492 |
| Provider Name | Trina Rena Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932616190 PECOS PAC ID: 8426319468 Enrollment ID: I20180307002387 |
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