Healthcare Provider Details

I. General information

NPI: 1720254949
Provider Name (Legal Business Name): NEVADA CANCER INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BREAKTHROUGH WAY
LAS VEGAS NV
89135-3011
US

IV. Provider business mailing address

PO BOX 98809
LAS VEGAS NV
89193-8809
US

V. Phone/Fax

Practice location:
  • Phone: 702-822-5433
  • Fax: 702-944-0451
Mailing address:
  • Phone: 702-822-5433
  • Fax: 702-944-2380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: SANDRA MURDOCH
Title or Position: CEO/PRESIDENT
Credential:
Phone: 702-822-5433