Organization
CENTENNIAL MEDICAL GROUP
Active
Other names
Centennial Upright MRI
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CARLA SHERWOOD (OPERATIONS DIRECTOR)
(702) 818-2825
Entity
Organization
Contact information
Practice address
4640 W CRAIG RD, N LAS VEGAS, NV 89032-2743
(702) 839-1203
(702) 507-0992
Mailing address
4454 N DECATUR BLVD, LAS VEGAS, NV 89130-5286
(702) 839-1203
(702) 507-0992
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
V103360
MEDICARE P-10
NV
Enumeration date
06/20/2008
Last updated
06/20/2008
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