Healthcare Provider Details

I. General information

NPI: 1992281869
Provider Name (Legal Business Name): CENTER FOR WELLNESS AND PAIN CARE OF LAS VEGAS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3426 BROADWAY STE 101
EVERETT WA
98201-5098
US

IV. Provider business mailing address

311 N BUFFALO DR STE A
LAS VEGAS NV
89145-0375
US

V. Phone/Fax

Practice location:
  • Phone: 702-476-9700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: NEVILLE CAMPBELL
Title or Position: FOUNDER/MEDICAL DIRECTOR
Credential:
Phone: 702-476-9700