Provider Demographics
NPI:1295386936
Name:VEGAS MD
Entity Type:Organization
Organization Name:VEGAS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:MARICELJEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RYCRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:725-214-1009
Mailing Address - Street 1:5300 SPRING MOUNTAIN RD STE 112
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-8724
Mailing Address - Country:US
Mailing Address - Phone:725-232-8649
Mailing Address - Fax:
Practice Address - Street 1:5300 SPRING MOUNTAIN RD STE 112
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-8724
Practice Address - Country:US
Practice Address - Phone:702-362-6373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-24
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty