Forma Integrated Healthcare
Specialist in Las Vegas, NV. Organization (NPI-2).
NPI number1023964657
StatusActive
Last updated in NPPESMar 9, 2026
Details
- NPI
- 1023964657
- Entity type
- Organization (NPI-2)
- Legal business name
- Forma Integrated Healthcare
- Organization subpart
- No
- Enumeration date
- Mar 6, 2026
- Certification date
- Mar 9, 2026
- Last updated
- Mar 9, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PART B SUPPLIER - CLINIC/GROUP PRACTICE
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 174400000X | Specialist | – | – | Yes |
| 363LF0000X | Nurse Practitioner, Family | – | – | |
| 207Q00000X | Family Medicine | – | – | |
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | – | – | |
| 163WW0000X | Registered Nurse, Wound Care | – | – | |
| 103TF0000X | Psychologist, Family | – | – |
Practice location
2655 S Rainbow Blvd Ste 410Las Vegas, NV 89146-5100
Phone 702-726-9722 · Fax 702-906-0067
Mailing address
2655 S Rainbow Blvd Ste 410Las Vegas, NV 89146-5100
Phone 702-726-9722 · Fax 702-906-0067
Authorized official
Ann Uganiza
Ceo
7025314540
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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