Provider Demographics
NPI:1972629525
Name:CARL R LEVISEUR MD PC
Entity type:Organization
Organization Name:CARL R LEVISEUR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVISEUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-727-6400
Mailing Address - Street 1:PO BOX 1940
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89041-1940
Mailing Address - Country:US
Mailing Address - Phone:775-727-6400
Mailing Address - Fax:775-727-7543
Practice Address - Street 1:2270 COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-4704
Practice Address - Country:US
Practice Address - Phone:775-727-6400
Practice Address - Fax:775-727-7543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002412007Medicaid
NV002012004Medicaid
NV32851Medicare ID - Type UnspecifiedCARL R LEVISEUR MD
NV002412007Medicaid
NV002012004Medicaid
NVS21979Medicare UPIN