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General NPI Number Information
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NPI Number | 1316169980
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Entity Type | Organization
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Legal Business Name | SWANLAKE MEDICAL CENTER
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 01/04/2010
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Provider Practice Location Address
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Address Line | 3330 S HUALAPAI WAY SUITE #120
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City | LAS VEGAS
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State | NV
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Zip | 89117-7716
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Country | US
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Telephone | 702-765-5253
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Fax | 702-765-5354
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Provider Business Mailing Address
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Address Line | 3330 S HUALAPAI WAY SUITE #120
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City | LAS VEGAS
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State | NV
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Zip | 89117-7716
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Country | US
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Telephone | 702-765-5253
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Fax | 702-765-5354
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VICTOR R BRUCE
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Credential | MD
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Telephone | 702-765-5253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 9484
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 8652
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 8652
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License Number State | NV
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