Healthcare Provider Details

I. General information

NPI: 1811799141
Provider Name (Legal Business Name): VEGAS ONE ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3097 S DECATUR BLVD
LAS VEGAS NV
89102-9130
US

IV. Provider business mailing address

243 GARDEN ARBOR CT
LAS VEGAS NV
89148-5285
US

V. Phone/Fax

Practice location:
  • Phone: 702-482-4551
  • Fax: 308-633-7379
Mailing address:
  • Phone: 702-482-4551
  • Fax: 308-633-7379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: TERRY HIMES
Title or Position: OWNER
Credential:
Phone: 702-482-4551