Provider Demographics
NPI:1053525485
Name:DAVID R. MENDENHALL M.D., LTD.
Entity type:Organization
Organization Name:DAVID R. MENDENHALL M.D., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:REYNOLDS
Authorized Official - Last Name:MENDENHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-384-3200
Mailing Address - Street 1:501 S RANCHO DR
Mailing Address - Street 2:SUITE F-41
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4828
Mailing Address - Country:US
Mailing Address - Phone:702-384-3200
Mailing Address - Fax:702-384-5276
Practice Address - Street 1:501 S RANCHO DR
Practice Address - Street 2:SUITE F-41
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4828
Practice Address - Country:US
Practice Address - Phone:702-384-3200
Practice Address - Fax:702-384-5276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2741261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVC96339Medicare UPIN
NVVMD2741Medicare ID - Type Unspecified