Provider Demographics
NPI:1093380222
Name:LAS VEGAS COMPREHENSIVE PAIN MANAGEMENT CENTER PC
Entity Type:Organization
Organization Name:LAS VEGAS COMPREHENSIVE PAIN MANAGEMENT CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING CONTRACT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-640-5555
Mailing Address - Street 1:8930 W SUNSET RD STE 350
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5042
Mailing Address - Country:US
Mailing Address - Phone:702-463-8548
Mailing Address - Fax:702-463-8384
Practice Address - Street 1:8930 W SUNSET RD STE 350
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5042
Practice Address - Country:US
Practice Address - Phone:702-463-8548
Practice Address - Fax:702-463-8384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty