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NPI Code Detail

MEDICARE: EXTENSIVE PAIN PRIMARY AND URGENT CARE CENTER OF NEVADA.LLC

MEDICARE: EXTENSIVE PAIN PRIMARY AND URGENT CARE CENTER OF NEVADA.LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

General Provider Information

NPI Number : 1366092462
Entity Type Code : Organization
Provider Name (Legal Business Name) : EXTENSIVE PAIN PRIMARY AND URGENT CARE CENTER OF NEVADA.LLC
Provider Business Mailing Address
First Line : 6465 W SAHARA AVE STE 103
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-3071
Country : US
Telephone Number : 702-822-1881
Fax Number : 702-787-9635
Provider Business Practice Location Address
First Line : 6465 W SAHARA AVE STE 103
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-3071
Country : US
Telephone Number : 702-822-1881
Fax Number : 702-822-1880
Authorized Official
Title or Position : OWNERCEO
Name : DR. TWYLA RASHELLE RUSSELL
Credential : BSN,MSN,APRN, FNP-BC
Telephone Number : 702-822-1881
Provider Enumeration Date : 09/19/2019
Last Update Date : 11/21/2019

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Directions to “EXTENSIVE PAIN PRIMARY AND URGENT CARE CENTER OF NEVADA.LLC ” Practice Location

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