Provider Demographics
NPI:1508998717
Name:WILLIAM NEAL EVANS, MD, LTD
Entity Type:Organization
Organization Name:WILLIAM NEAL EVANS, MD, LTD
Other - Org Name:CHILDREN'S HEART CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD, CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:N
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-732-1290
Mailing Address - Street 1:3006 S MARYLAND PKWY
Mailing Address - Street 2:SUITE 690
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2218
Mailing Address - Country:US
Mailing Address - Phone:702-732-1290
Mailing Address - Fax:702-732-1385
Practice Address - Street 1:1301 BERTHA HOWE AVE
Practice Address - Street 2:SUITE # 1
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-7502
Practice Address - Country:US
Practice Address - Phone:702-732-1290
Practice Address - Fax:702-732-1385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
XGG007170OtherMEDI-CAL
NV100500157Medicaid
XGG007170OtherMEDI-CAL