# VAN WAGNER IMMEDIATE CARE CENTER

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** VAN WAGNER HEALTHCARE MANAGEMENT
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1790936458
- **Legal business name:** VAN WAGNER HEALTHCARE MANAGEMENT
- **Authorized official:** DR. KELLY ELAN VAN WAGNER M.D. (OWNER)
- **Authorized official phone:** (702) 990-0333

## Contact information

- **Practice address:** 2360 CORPORATE CIR, SUITE 100, HENDERSON, NV 89074-7722
- **Practice address phone:** (702) 990-0333
- **Practice address fax:** (702) 990-0336
- **Mailing address:** 2225 VILLAGE WALK DR, SUITE 270, HENDERSON, NV 89052-5679
- **Mailing address phone:** (702) 990-0333
- **Mailing address fax:** (702) 990-0336

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QU0200X | Urgent Care Clinic/Center | 9533 | NV | Yes |

## Other

- **Enumeration date:** 09/30/2008
- **Last updated:** 10/01/2008