Provider Demographics
NPI:1437158771
Name:NEVADA ORTHOPEDIC & SPINE CENTER
Entity Type:Organization
Organization Name:NEVADA ORTHOPEDIC & SPINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL STAFF CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAPOLLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-258-5521
Mailing Address - Street 1:7455 W WASHINGTON AVE
Mailing Address - Street 2:#160
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-4337
Mailing Address - Country:US
Mailing Address - Phone:702-878-0393
Mailing Address - Fax:
Practice Address - Street 1:7455 W WASHINGTON AVE
Practice Address - Street 2:#160
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-4337
Practice Address - Country:US
Practice Address - Phone:702-878-0393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVC14-00279-3-092590207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100505991Medicaid
NV100505991Medicaid
NVVWCHTNMedicare PIN
NV0894150001Medicare NSC