Provider Demographics
NPI:1497271399
Name:CENTER FOR WELLNESS AND PAIN CARE OF LAS VEGAS INC
Entity Type:Organization
Organization Name:CENTER FOR WELLNESS AND PAIN CARE OF LAS VEGAS INC
Other - Org Name:THE CENTER FOR WELLNESS AND PAIN CARE OF LAS VEGAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TASHI
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:702-476-9700
Mailing Address - Street 1:311 N BUFFALO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-0375
Mailing Address - Country:US
Mailing Address - Phone:702-476-9700
Mailing Address - Fax:702-476-9138
Practice Address - Street 1:1701 7B N GREEN VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074
Practice Address - Country:US
Practice Address - Phone:702-476-9700
Practice Address - Fax:702-476-9138
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR WELLNESS AND PAIN CARE OF LAS VEGAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-22
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207LP2900X, 208VP0000X
NV15175208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty