Provider Demographics
NPI:1366630543
Name:AFFILIATED HEALTHCARE, LLC
Entity type:Organization
Organization Name:AFFILIATED HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMMON
Authorized Official - Middle Name:
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-727-8900
Mailing Address - Street 1:2201 POSTAL DR
Mailing Address - Street 2:STE 8
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-4777
Mailing Address - Country:US
Mailing Address - Phone:775-727-8900
Mailing Address - Fax:775-727-9452
Practice Address - Street 1:1240 E STATE ST
Practice Address - Street 2:STE 105
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-2153
Practice Address - Country:US
Practice Address - Phone:775-727-8900
Practice Address - Fax:775-727-9452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV105143Medicare PIN