Provider Demographics
NPI:1184835993
Name:LAS VEGAS INTERNATIONAL CENTER FOR ADVANCE GYNECOLOGIC CARE
Entity Type:Organization
Organization Name:LAS VEGAS INTERNATIONAL CENTER FOR ADVANCE GYNECOLOGIC CARE
Other - Org Name:RICHARD CHUDACOFF MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUDACOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-360-9630
Mailing Address - Street 1:3150 N TENAYA WAY
Mailing Address - Street 2:270
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0443
Mailing Address - Country:US
Mailing Address - Phone:702-798-3008
Mailing Address - Fax:702-869-4763
Practice Address - Street 1:3150 N TENAYA WAY
Practice Address - Street 2:270
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0443
Practice Address - Country:US
Practice Address - Phone:702-798-3008
Practice Address - Fax:702-869-4763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12108207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty