Organization
EMPOWERED PAIN PRIMARY AND URGENT CARE CENTER OF NEVADA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES RUSSELL (MANAGER)
(702) 787-9637
Entity
Organization
Contact information
Practice address
6465 W SAHARA AVE STE 103, LAS VEGAS, NV 89146-3071
(702) 822-1881
(702) 822-1880
Mailing address
6465 W SAHARA AVE STE 103, LAS VEGAS, NV 89146-3071
(702) 822-1881
(702) 822-1880
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
363L00000X
Nurse Practitioner
—
—
363LA2100X
Acute Care Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LC0200X
Critical Care Medicine Nurse Practitioner
—
—
363LC1500X
Community Health Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
250018412
—
NV
01
—
B202102081415526
NEVADA SECRETARY OF STATE
NV
Enumeration date
02/09/2021
Last updated
10/28/2022
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