Provider Demographics
NPI:1720110190
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 1:653 N TOWN CENTER DR STE 114
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0515
Mailing Address - Country:US
Mailing Address - Phone:702-732-1290
Mailing Address - Fax:702-732-1385
Practice Address - Street 1:653 TOWN CENTER DR.
Practice Address - Street 2:SUITE 310
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144
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:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100500157Medicaid
XGG007170OtherMEDI-CAL
WCLCQMedicare PIN