Healthcare Provider Details

I. General information

NPI: 1053992784
Provider Name (Legal Business Name): INTERVENTIONAL MEDICAL SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 S JONES BLVD # 1454
LAS VEGAS NV
89107-2623
US

IV. Provider business mailing address

304 S JONES BLVD # 1454
LAS VEGAS NV
89107-2623
US

V. Phone/Fax

Practice location:
  • Phone: 626-399-6834
  • Fax: 702-357-4415
Mailing address:
  • Phone: 626-399-6834
  • Fax: 702-357-4415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALLEN SCOTT MILLER
Title or Position: MANAGER
Credential: DC
Phone: 626-399-6834