Healthcare Provider Details

I. General information

NPI: 1821405325
Provider Name (Legal Business Name): SYNERGY INDUSTRIAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3233 W CHARLESTON BLVD SUITE 203
LAS VEGAS NV
89102-1938
US

IV. Provider business mailing address

7200 CATHEDRAL ROCK DR SUITE 210
LAS VEGAS NV
89128-0438
US

V. Phone/Fax

Practice location:
  • Phone: 702-551-0004
  • Fax: 702-551-0004
Mailing address:
  • Phone: 702-551-0004
  • Fax: 702-551-0004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number954
License Number StateNV

VIII. Authorized Official

Name: DR. THOMAS L. VATER
Title or Position: ORTHOPAEDIC SURGEON
Credential: D.O.
Phone: 702-430-5000