Provider Demographics
NPI:1053696245
Name:NEVADA PHYSICIANS SPECIALISTS TOY
Entity type:Organization
Organization Name:NEVADA PHYSICIANS SPECIALISTS TOY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRANQUILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-463-9100
Mailing Address - Street 1:624 S TONOPAH DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4029
Mailing Address - Country:US
Mailing Address - Phone:702-463-9100
Mailing Address - Fax:702-685-9991
Practice Address - Street 1:3980 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5102
Practice Address - Country:US
Practice Address - Phone:702-463-9100
Practice Address - Fax:702-685-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty