Organization
VAN WAGNER IMMEDIATE CARE CENTER
Active
Parent organization
VAN WAGNER HEALTHCARE MANAGEMENT
Organization subpart
Yes
Provider details
NPI number
Legal business name
VAN WAGNER HEALTHCARE MANAGEMENT
Authorized official
DR. KELLY ELAN VAN WAGNER M.D. (OWNER)
(702) 990-0333
Entity
Organization
Contact information
Practice address
2360 CORPORATE CIR, SUITE 100, HENDERSON, NV 89074-7722
(702) 990-0333
(702) 990-0336
Mailing address
2225 VILLAGE WALK DR, SUITE 270, HENDERSON, NV 89052-5679
(702) 990-0333
(702) 990-0336
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
9533
NV
Other
Enumeration date
09/30/2008
Last updated
10/01/2008
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