Healthcare Provider Details

I. General information

NPI: 1518915834
Provider Name (Legal Business Name): NEWPORT MRI A NEVADA LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7140 SMOKE RANCH RD STE. 150
LAS VEGAS NV
89128-3157
US

IV. Provider business mailing address

7140 SMOKE RANCH RD STE. 150
LAS VEGAS NV
89128-3157
US

V. Phone/Fax

Practice location:
  • Phone: 702-870-4674
  • Fax: 702-839-4849
Mailing address:
  • Phone: 702-320-8111
  • Fax: 702-320-8112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number233260
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number233260
License Number StateNV

VIII. Authorized Official

Name: DR. JASWINDER GROVER
Title or Position: ORTHOPAEDIC SPINE SURGEON
Credential: M.D
Phone: 702-839-4810