Provider Demographics
NPI:1902081136
Name:ANTHONY C RUGGEROLI MD LTD
Entity Type:Organization
Organization Name:ANTHONY C RUGGEROLI MD LTD
Other - Org Name:MCKENNA AND RUGGEROLI PAIN SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:RUGGEROLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-307-7700
Mailing Address - Street 1:PO BOX 370427
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89137-0427
Mailing Address - Country:US
Mailing Address - Phone:702-307-7700
Mailing Address - Fax:702-307-7942
Practice Address - Street 1:6070 S FORT APACHE RD
Practice Address - Street 2:STE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5615
Practice Address - Country:US
Practice Address - Phone:702-307-7700
Practice Address - Fax:702-307-7942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8127207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVG00736Medicare UPIN