Provider Demographics
NPI:1235874082
Name:PREMIER TREATMENT CENTERS OF NV
Entity Type:Organization
Organization Name:PREMIER TREATMENT CENTERS OF NV
Other - Org Name:MODERN PAIN TREATMENT CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:312-401-4557
Mailing Address - Street 1:PO BOX 8389
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33775-8389
Mailing Address - Country:US
Mailing Address - Phone:312-401-4557
Mailing Address - Fax:
Practice Address - Street 1:3201 S MARYLAND PKWY STE 318
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2425
Practice Address - Country:US
Practice Address - Phone:702-665-8390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-04
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty