Provider Demographics
NPI:1457920068
Name:COMMUNITY OUTREACH MEDICAL CENTER
Entity type:Organization
Organization Name:COMMUNITY OUTREACH MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:OGDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-657-3873
Mailing Address - Street 1:1090 E DESERT INN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2803
Mailing Address - Country:US
Mailing Address - Phone:702-657-3873
Mailing Address - Fax:
Practice Address - Street 1:1090 E DESERT INN RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2803
Practice Address - Country:US
Practice Address - Phone:702-657-3873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY OUTREACH MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-18
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Yes251S00000XAgenciesCommunity/Behavioral Health