LAS VEGAS PAIN RELIEF CENTERS(RUSSO),PC (NPI# 1053754630) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053754630 |
| Entity Type | Organization |
| Organization Name | LAS VEGAS PAIN RELIEF CENTERS(RUSSO),PC |
| Other Organization Name | LAS VEGAS PAIN RELIEF CENTER |
| Practice Address |
58 N Pecos Rd Henderson NV 89074-7319 |
| Practice Telephone | 7029482520 |
| Practice Fax Number | 7029482523 |
| Mailing Telephone | 7029482520 |
| Mailing Fax Number | 7029482523 |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2015-03-02 |
| Authorized Official Name | MR. JON S PETRICK (CLINICAL DIRECTOR) |
| Authorized Official Telephone | 7029482520 |
| Authorized Official Credential | D.C. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 111NS0005X |
Chiropractor Specialization: Sports Physician |
B00848 | NV | Chiropractic Providers |
| Y | 207RS0010X |
Internal Medicine Specialization: Sports Medicine |
4511 | NV | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Las Vegas Pain Relief Center | Doing Business As Name - Organization |
| Street Address |
58 N PECOS RD |
| City | HENDERSON |
| State | NV |
| Zip Code | 89074-7319 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083611362 | Edgardo Averion Faylona | Internal Medicine | 58 N Pecos Rd, Henderson, NV 89074-7319 | 2005-07-01 |
| 1184777591 | Kintaro Oku | Chiropractor | 58 N Pecos Rd, Henderson, NV 89074-7319 | 2007-01-19 |
| 1083763502 | Jon S Petrick | Chiropractor | 58 N Pecos Rd, Henderson, NV 89074-7319 | 2007-01-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194349381 | Samuel Taylor Mulford | Physical Therapist | 9070 W.cheyenne Ave, Suite 100, Henderson, NV 89074 | 2020-06-03 |
| 1407369127 | Brenda Thomas | Dental Hygienist | 234 Polar Morning Place, Henderson, NV 89074 | 2017-11-16 |
| 1174036479 | Gail E Evans Wade | Behavioral Analyst | 1445 Stone Lake Cove, Henderson, NV 89074 | 2017-11-08 |
| 1710400957 | Kimberley Houk | Behavioral Analyst | 20 Avenida Picasso, Henderson, NV 89074 | 2017-07-19 |
| 1760911846 | Colin Ono-moore | Physical Therapist | 3 Rising Sun Ct, Henderson, NV 89074 | 2017-06-12 |
| 1851825764 | Ralph Wieder | Dietitian, Registered | 1005 Wigwam Pkwy, 23206, Henderson, NV 89074 | 2017-04-18 |
| 1811421712 | Henderson Long Term Care LLC | Skilled Nursing Facility | 2965 Wigwam Parkway, Henderson, NV 89074 | 2017-04-18 |
| 1275994642 | Malyna Lavarias | Behavioral Analyst | 74 N Pecos Rd., Suite C, Henderson, NV 89074 | 2016-03-14 |
| 1144608290 | Matthew Roderick | Acupuncturist | 2675 Windmill Pkwy Apt 421, Henderson, NV 89074 | 2015-05-08 |
| 1922494764 | Jennifer Romo Santistevan | Pediatrics | 1505 Wigwam Pkwy Ste 230, Henderson, NV 89074 | 2015-04-08 |
| Find all providers in zip 89074 | ||||
| Taxonomy Code | 207RS0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Sports Medicine |
| An internist trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the healthcare of the individual. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588129530 | Jordan W. Edwards, Md, Ltd | Internal Medicine | 1351 Corporate Blvd, Reno, NV 89502-7102 | 2019-02-04 |
Please comment or provide details below to improve the information on LAS VEGAS PAIN RELIEF CENTERS(RUSSO),PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.