Provider Demographics
NPI:1730194499
Name:LAS VEGAS STAT CARE INC.
Entity type:Organization
Organization Name:LAS VEGAS STAT CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:M.
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:MADRID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-454-7945
Mailing Address - Street 1:PO BOX 2545
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-2545
Mailing Address - Country:US
Mailing Address - Phone:505-454-7945
Mailing Address - Fax:505-425-7196
Practice Address - Street 1:260 MILLS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4125
Practice Address - Country:US
Practice Address - Phone:505-425-6283
Practice Address - Fax:505-425-7196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM51932253Medicaid