Healthcare Provider Details

I. General information

NPI: 1760664973
Provider Name (Legal Business Name): NEVADA CANCER INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BREAKTHROUGH WAY
LAS VEGAS NV
89135
US

IV. Provider business mailing address

1 BREAKTHROUGH WAY
LAS VEGAS NV
89135
US

V. Phone/Fax

Practice location:
  • Phone: 702-822-5433
  • Fax:
Mailing address:
  • Phone: 702-822-5433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. EVELYN ROSE COKER
Title or Position: DIRECTOR OF MANAGED CARE
Credential:
Phone: 702-822-5199