NPIMap

Organization Active NPI

Modern Gentlemen MD PLLC

  • Urgent Care Clinic/Center
  • Las Vegas, NV
National Provider Identifier
1609536010
Registry record updated Feb 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
MODERN GENTLEMEN MD PLLC
Practice address
8432 Ravencrest St
Las Vegas, NV 89139-6874
Phone
(206) 551-0154
NPI assigned
Dec 27, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael Minckler, MDNPI 1821437484
Title
Owner
Phone
(833) 436-8633

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Care Clinic/Center 261QE0002X
Health Service Clinic/Center 261QH0100X
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

8432 Ravencrest St
Las Vegas, NV 89139-6874

Mailing address

PO Box 1992
Yuma, AZ 85366-2391

Other names 1

  • Valley Express Med Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1640563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643846400000",
    "number": "1609536010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1992",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853662391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8432 RAVENCREST ST",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891396874",
            "telephone_number": "206-551-0154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN GENTLEMEN MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-27",
        "last_updated": "2022-02-03",
        "certification_date": "2022-02-03",
        "status": "A",
        "authorized_official_last_name": "MINCKLER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "833-436-8633",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0002X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Emergency Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valley Express Med",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Valley Express Med",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.