Basic Information
| Provider Information | |||||||||
| NPI: | 1528122777 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EDEN | ||||||||
| FirstName: | TROY | ||||||||
| MiddleName: | |||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 E SILVERADO RANCH BLVD STE 170 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891837518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022406482 | ||||||||
| FaxNumber: | 7028040957 | ||||||||
| Practice Location | |||||||||
| Address1: | 762 14TH ST | ||||||||
| Address2: | |||||||||
| City: | ELKO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 898013413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022406482 | ||||||||
| FaxNumber: | 7022408529 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2006 | ||||||||
| LastUpdateDate: | 12/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA1026 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | V105503 | 01 | NV | TROY'S PTAN | OTHER | V105461 | 01 | NV | EDEN MEDICAL PTAN | OTHER |