Healthcare Provider Details

I. General information

NPI: 1740403658
Provider Name (Legal Business Name): PBS ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 PEAK DR STE 100
LAS VEGAS NV
89128-9028
US

IV. Provider business mailing address

7250 PEAK DR STE 100
LAS VEGAS NV
89128-9028
US

V. Phone/Fax

Practice location:
  • Phone: 702-386-4700
  • Fax: 702-386-4701
Mailing address:
  • Phone: 702-386-4700
  • Fax: 702-386-4701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateNV

VIII. Authorized Official

Name: MRS. BETH A JOHNSON
Title or Position: DIRECTOR OF OPERATIONS OWNER
Credential:
Phone: 702-386-4700