NPIMap

Organization Active NPI

Vegas Innovative Psychiatry

  • Multi-Specialty Clinic/Center
  • Las Vegas, NV
National Provider Identifier
1053931576
Registry record updated Aug 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
VEGAS INNOVATIVE PSYCHIATRY
Doing business as
Vegas Innovative Psychiatry
Practice address
1721 E Charleston Blvd
Las Vegas, NV 89104-1902
Phone
(702) 685-0620
Fax
(702) 685-9674
NPI assigned
Apr 24, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2020

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

Authorized official

Name
Maria Fernanda Mitchell
Title
Program Director
Phone
(702) 580-1850

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

1721 E Charleston Blvd
Las Vegas, NV 89104-1902

Mailing address

1721 E Charleston Blvd
Las Vegas, NV 89104-1902
Phone (702) 685-0620

Other identifiers 1

IdentifierTypeStateIssuer
E6055912020-0MedicaidNV

Other names 1

  • Vegas Innovative Psychiatry Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL PBO

National Provider Directory

National Provider Directory
Tax ID family
Vegas Innovative Psychiatry3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1587686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596412800000",
    "number": "1053931576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1721 E CHARLESTON BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891041902",
            "telephone_number": "702-685-0620",
            "fax_number": "702-685-9674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 E CHARLESTON BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891041902",
            "telephone_number": "702-685-0620",
            "fax_number": "702-685-9674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VEGAS INNOVATIVE PSYCHIATRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-24",
        "last_updated": "2020-08-03",
        "certification_date": "2020-08-03",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "FERNANDA",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "702-580-1850"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "E6055912020-0",
            "state": "NV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "PBO",
            "affiliation": "N",
            "endpointDescription": "PBO",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2021 Paseo del Prado",
            "address_2": "suite A 120",
            "city": "Las Vegas",
            "state": "NV",
            "country_code": "US",
            "postal_code": "891020045",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Vegas Innovative Psychiatry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vegas Innovative Psychiatry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2020; 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.