Provider Demographics
NPI:1538667795
Name:CENTER FOR WELLNESS AND PAIN CARE OF WASHINGTON
Entity Type:Organization
Organization Name:CENTER FOR WELLNESS AND PAIN CARE OF WASHINGTON
Other - Org Name:CENTER FOR WELLNESS AND PAIN CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:NEVILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-476-9700
Mailing Address - Street 1:311 N BUFFALO DR STE A
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 1:3426 BROADWAY STE 101
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-5098
Practice Address - Country:US
Practice Address - Phone:702-476-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR WELLNESS AND PAIN CARE OF LAS VEGAS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15175207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty