Healthcare Provider Details

I. General information

NPI: 1588121941
Provider Name (Legal Business Name): ANDREW HALL MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2019
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date: 04/25/2024
Reactivation Date: 05/22/2024

III. Provider practice location address

6064 S FORT APACHE RD STE 100
LAS VEGAS NV
89148-5350
US

IV. Provider business mailing address

6064 S FORT APACHE RD STE 100
LAS VEGAS NV
89148-5350
US

V. Phone/Fax

Practice location:
  • Phone: 702-940-8007
  • Fax: 702-832-1940
Mailing address:
  • Phone: 702-940-8007
  • Fax: 702-832-1940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PETE BEKAS
Title or Position: ADMINISTRATOR
Credential:
Phone: 702-832-1940