Provider Demographics
NPI:1356389456
Name:LONE MOUNTAIN MEDICAL CENTRE
Entity type:Organization
Organization Name:LONE MOUNTAIN MEDICAL CENTRE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:WELDON
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-645-8126
Mailing Address - Street 1:4830 W LONE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-2239
Mailing Address - Country:US
Mailing Address - Phone:702-645-8126
Mailing Address - Fax:702-645-2828
Practice Address - Street 1:4830 W LONE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2239
Practice Address - Country:US
Practice Address - Phone:702-645-8126
Practice Address - Fax:702-645-2828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV493207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCS13274OtherNV STATE BOARD OF PHARMAC
NV493OtherNV STATE BOARD OF OSTEOPA