Provider Demographics
NPI:1770665002
Name:LAS VEGAS NEUROSURGERY & SPINE CARE LLC
Entity Type:Organization
Organization Name:LAS VEGAS NEUROSURGERY & SPINE CARE LLC
Other - Org Name:LAS VEGAS NEUROSURGERY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-737-7753
Mailing Address - Street 1:8285 W ARBY AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2236
Mailing Address - Country:US
Mailing Address - Phone:702-737-7753
Mailing Address - Fax:702-407-7066
Practice Address - Street 1:8285 W ARBY AVE STE 220
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2236
Practice Address - Country:US
Practice Address - Phone:702-737-7753
Practice Address - Fax:702-407-7066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7950207T00000X
NV10718207T00000X
NV6485207T00000X
NV6355207T00000X
207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100511147Medicaid