Provider Demographics
NPI:1467755256
Name:LAS VEGAS IMMEDIATE CARE
Entity Type:Organization
Organization Name:LAS VEGAS IMMEDIATE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:LUIGI
Authorized Official - Last Name:CARULLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-255-0500
Mailing Address - Street 1:2901 N TENAYA WAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128
Mailing Address - Country:US
Mailing Address - Phone:702-255-0500
Mailing Address - Fax:702-821-1704
Practice Address - Street 1:2901 N TENAYA WAY
Practice Address - Street 2:SUITE 210
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:702-255-0500
Practice Address - Fax:702-821-1704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13661261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care