Provider Demographics
NPI:1578026795
Name:MSO SERVICES
Entity Type:Organization
Organization Name:MSO SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MUYIWA
Authorized Official - Middle Name:S
Authorized Official - Last Name:OLOJIDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-955-6759
Mailing Address - Street 1:3450 E RUSSELL RD STE 208
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-2201
Mailing Address - Country:US
Mailing Address - Phone:702-955-6759
Mailing Address - Fax:
Practice Address - Street 1:3450 E RUSSELL RD STE 208
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-2201
Practice Address - Country:US
Practice Address - Phone:702-955-6759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-14
Last Update Date:2019-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health