NPI 1134628480 · live from the CMS NPI Registry
Bacchus PC
Family Medicine in Henderson, NV. National Provider Identifier 1134628480, active.
NPI record
| NPI | 1134628480 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Family Medicine 207Q00000X |
| Practice location | 880 Seven Hills Dr Ste 140, Henderson, NV 89052 |
| Practice phone | 702-844-4840 |
| Mailing address | 2370 Corporate Cir Ste 300, Henderson, NV 89074 |
| Enumerated | February 1, 2018 |
| Last updated | April 1, 2026 |
| Authorized official | Beverly Dendary, Credentialing Manager |
| Other names | P3 Health Partners Medical Group |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner | 363L00000X | — |
| Internal Medicine | 207R00000X | — |
| Physician Assistant | 363A00000X | — |
| Clinic/Center, Urgent Care | 261QU0200X | — |
| General Practice | 208D00000X | — |
| Family Medicine primary | 207Q00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.