NPIMap

Organization Active NPI

Las Vegas International Center for Advance Gynecologic Care

  • Gynecology Physician
  • Las Vegas, NV
National Provider Identifier
1184835993
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
12108 Issued in NV
Legal business name
LAS VEGAS INTERNATIONAL CENTER FOR ADVANCE GYNECOLOGIC CARE
Practice address
3150 N Tenaya Way
270
Las Vegas, NV 89128-0443
Phone
(702) 798-3008
Fax
(702) 869-4763
NPI assigned
May 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Richard Chudacoff, MD
Title
Owner
Phone
(702) 360-9630

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VG0400X 12108 NV Primary

Addresses

Primary practice location

3150 N Tenaya Way
270
Las Vegas, NV 89128-0443

Mailing address

3150 N Tenaya Way
270
Las Vegas, NV 89128-0443
Phone (702) 798-3008

Other names 1

  • RICHARD CHUDACOFF MD Doing business as

National Provider Directory

National Provider Directory

Locations

3150 N Tenaya Way
Ste 270
Las Vegas, NV 89128
Phone (702) 360-9630

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1184835993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3150 N TENAYA WAY",
            "address_2": "270",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280443",
            "telephone_number": "702-798-3008",
            "fax_number": "702-869-4763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3150 N TENAYA WAY",
            "address_2": "270",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280443",
            "telephone_number": "702-798-3008",
            "fax_number": "702-869-4763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAS VEGAS INTERNATIONAL CENTER FOR ADVANCE GYNECOLOGIC CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHUDACOFF",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-360-9630",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "NV",
            "license": "12108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RICHARD CHUDACOFF MD",
            "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 22, 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.