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NPI Code Detail

MEDICARE: EMPOWERED PAIN PRIMARY AND URGENT CARE CENTER OF NEVADA LLC

MEDICARE: EMPOWERED PAIN PRIMARY AND URGENT CARE CENTER OF NEVADA LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician
2208VP0000XPain Medicine Physician
3208VP0014XInterventional Pain Medicine Physician
4363L00000XNurse Practitioner
5363LA2100XAcute Care Nurse Practitioner
6363LA2200XAdult Health Nurse Practitioner
7363LC0200XCritical Care Medicine Nurse Practitioner
8363LC1500XCommunity Health Nurse Practitioner
9363LP2300XPrimary Care Nurse Practitioner

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1B202102081415526OTHERNVNEVADA SECRETARY OF STATE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912599168
Entity Type Code : Organization
Provider Name (Legal Business Name) : EMPOWERED PAIN PRIMARY AND URGENT CARE CENTER OF NEVADA LLC
Provider Business Mailing Address
First Line : 6465 W SAHARA AVE STE 103
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-3071
Country : US
Telephone Number : 702-822-1881
Fax Number : 702-822-1880
Provider Business Practice Location Address
First Line : 6465 W SAHARA AVE STE 103
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-3071
Country : US
Telephone Number : 702-822-1881
Fax Number : 702-822-1880
Authorized Official
Title or Position : MANAGER
Name : MR. CHARLES RUSSELL
Credential :
Telephone Number : 702-787-9637
Provider Enumeration Date : 02/09/2021
Last Update Date : 10/28/2022

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Directions to “EMPOWERED PAIN PRIMARY AND URGENT CARE CENTER OF NEVADA LLC ” Practice Location

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