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General NPI Number Information
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NPI Number | 1366488470
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Entity Type | Organization
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Legal Business Name | TRI CITY MEDICAL SPECIALISTS LLC
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2365 REYNOLDS AVENUE BLDG C 2ND FLOOR
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City | N LAS VEGAS
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State | NV
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Zip | 89030
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Country | US
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Telephone | 702-588-7070
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Fax | 702-839-0149
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Provider Business Mailing Address
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Address Line | 10777 W TWAIN AVENUE SUITE 225
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City | LAS VEGAS
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State | NV
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Zip | 89135
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Country | US
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Telephone | 702-839-0946
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Fax | 702-839-0149
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. DARREN RANDOLPH SWENSON
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Credential | M.D.
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Telephone | 702-839-0946
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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 | 11397
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License Number State | NV
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