Provider Demographics
NPI:1346458239
Name:KRAFT CENTER FOR PAIN CONTROL, LLC
Entity Type:Organization
Organization Name:KRAFT CENTER FOR PAIN CONTROL, LLC
Other - Org Name:ADVANCED PAIN CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-731-2642
Mailing Address - Street 1:2650 CRIMSON CANYON DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0841
Mailing Address - Country:US
Mailing Address - Phone:702-731-2642
Mailing Address - Fax:702-791-2070
Practice Address - Street 1:2650 CRIMSON CANYON DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0841
Practice Address - Country:US
Practice Address - Phone:702-731-2642
Practice Address - Fax:702-791-2070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV58853174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
V35391Medicare PIN