Healthcare Provider Details

I. General information

NPI: 1609116003
Provider Name (Legal Business Name): LAS VEGAS PROFESSIONAL GROUP - CALARCO, P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2465 E TWAIN AVE
LAS VEGAS NV
89121-4011
US

IV. Provider business mailing address

200 POWELL PL ATTN: LEGAL DEPARTMENT
BRENTWOOD TN
37027-7514
US

V. Phone/Fax

Practice location:
  • Phone: 615-727-8387
  • Fax: 615-457-8094
Mailing address:
  • Phone: 615-732-1605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number StateNV

VIII. Authorized Official

Name: MARK A CALARCO
Title or Position: FACILITY CEO
Credential: DO
Phone: 615-712-5862