Healthcare Provider Details

I. General information

NPI: 1497271399
Provider Name (Legal Business Name): CENTER FOR WELLNESS AND PAIN CARE OF LAS VEGAS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 02/07/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 7B N GREEN VALLEY PKWY
HENDERSON NV
89074
US

IV. Provider business mailing address

311 N BUFFALO DR
LAS VEGAS NV
89145-0375
US

V. Phone/Fax

Practice location:
  • Phone: 702-476-9700
  • Fax: 702-476-9138
Mailing address:
  • Phone: 702-476-9700
  • Fax: 702-476-9138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number15175
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. TASHI CAMPBELL
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 702-476-9700