Provider Demographics
NPI:1184111890
Name:PAIN CENTER OF HENDERSON LLC
Entity type:Organization
Organization Name:PAIN CENTER OF HENDERSON LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:OLENCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:702-476-5552
Mailing Address - Street 1:98 E. LAKE MEAD PKWY.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015
Mailing Address - Country:US
Mailing Address - Phone:702-476-5552
Mailing Address - Fax:702-476-5181
Practice Address - Street 1:98 E. LAKE MEAD PKWY. SUITE 202
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015
Practice Address - Country:US
Practice Address - Phone:702-476-5552
Practice Address - Fax:702-476-5181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12432512OtherCAQH