Provider Demographics
NPI:1508219833
Name:VEGAS MEDICAL CENTER PLLC
Entity Type:Organization
Organization Name:VEGAS MEDICAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:QUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HADUONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-763-4585
Mailing Address - Street 1:1701 W CHARLESTON BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2343
Mailing Address - Country:US
Mailing Address - Phone:702-763-4585
Mailing Address - Fax:702-921-9264
Practice Address - Street 1:1701 W CHARLESTON BLVD STE 600
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2343
Practice Address - Country:US
Practice Address - Phone:702-763-4585
Practice Address - Fax:702-921-9264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00862111N00000X
NV7683207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty