Healthcare Provider Details

I. General information

NPI: 1891205340
Provider Name (Legal Business Name): NEVADA TMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 01/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7391 PRAIRIE FALCON RD STE 150B
LAS VEGAS NV
89128-0815
US

IV. Provider business mailing address

PO BOX 370399
LAS VEGAS NV
89137-0399
US

V. Phone/Fax

Practice location:
  • Phone: 702-476-6300
  • Fax: 702-476-6575
Mailing address:
  • Phone: 702-476-6300
  • Fax: 702-476-6575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number10718
License Number StateNV

VIII. Authorized Official

Name: RAYMA CHARLENE WRIGHT
Title or Position: COORDINATOR
Credential:
Phone: 702-463-9193