Healthcare Provider Details

I. General information

NPI: 1730194499
Provider Name (Legal Business Name): LAS VEGAS STAT CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 MILLS AVE
LAS VEGAS NM
87701-4125
US

IV. Provider business mailing address

PO BOX 2545
LAS VEGAS NM
87701-2545
US

V. Phone/Fax

Practice location:
  • Phone: 505-425-6283
  • Fax: 505-425-7196
Mailing address:
  • Phone: 505-454-7945
  • Fax: 505-425-7196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNM

VIII. Authorized Official

Name: DR. M. EILEEN MADRID
Title or Position: BOARD PRESIDENT
Credential: MD
Phone: 505-454-7945