Las Vegas Pain Relief Centers(Russo),PC

Primary specialty

Sports Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0010X

License

4511 Issued in NV

Legal business name

LAS VEGAS PAIN RELIEF CENTERS(RUSSO),PC

Doing business as

Las Vegas Pain Relief Center

Practice address

58 N Pecos Rd
Henderson, NV 89074-7319

Phone

(702) 948-2520

Fax

(702) 948-2523

NPI assigned

Apr 12, 2013

Last updated

Mar 2, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jon S Petrick, D.C.NPI 1083763502

Title

Clinical Director

Phone

(702) 948-2520

Specialties & licenses 2

Addresses

Other names 1

• Las Vegas Pain Relief Center Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jon S Petrick, DC

  • Chiropractor
  • Henderson, NV
  • NPI 1083763502
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1365724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425254400000",
    "number": "1053754630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "58 N PECOS RD",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890747319",
            "telephone_number": "702-948-2520",
            "fax_number": "702-948-2523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "58 N PECOS RD",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890747319",
            "telephone_number": "702-948-2520",
            "fax_number": "702-948-2523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAS VEGAS PAIN RELIEF CENTERS(RUSSO),PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-12",
        "last_updated": "2015-03-02",
        "status": "A",
        "authorized_official_last_name": "PETRICK",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "702-948-2520",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "NV",
            "license": "B00848",
            "primary": false
        },
        {
            "code": "207RS0010X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sports Medicine",
            "state": "NV",
            "license": "4511",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Las Vegas Pain Relief Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Las Vegas Kidney & Hypertension Specialists LLC
• Las Vegas Mobile Medical Group PC
• Las Vegas Neck and Back Solutions LLC
• Las Vegas Physical Therapy LLC
• Las Vegas Recovery Hospital LLC
• Las Vegas Recovery Hospital LLC
• Las Vegas Scripts Care LLC
• Las Vegas Scripts RX LLC.

• Sports Medicine (Internal Medicine) Physician in Henderson, NV
• Providers in Henderson, NV by specialty
• Sports Medicine (Internal Medicine) Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.