NPIMap

Organization Active NPI

Shamloo Blue Sky Treatment Center PLLC

  • Medical Oncology Physician
  • Las Vegas, NV
National Provider Identifier
1487081048
Registry record updated Oct 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Oncology PhysicianTaxonomy code 207RX0202X
License
13639 Issued in NV
Legal business name
SHAMLOO BLUE SKY TREATMENT CENTER PLLC
Practice address
3150 N Tenaya Way
Suite 510
Las Vegas, NV 89128-0443
Phone
(702) 453-3799
NPI assigned
Sep 27, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2013

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

Authorized official

Name
Lori Labrecque
Title
Accts. MGR
Phone
(702) 453-3799

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Oncology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RX0202X 13639 NV Primary

Addresses

Primary practice location

3150 N Tenaya Way
Suite 510
Las Vegas, NV 89128-0443

Mailing address

PO Box 370457
Las Vegas, NV 89137-0457
Phone (702) 453-3799

Other identifiers 1

IdentifierTypeStateIssuer
13639OtherNVNV LIC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131029000806 NV Part B Supplier - Clinic/Group Practice 8426283417 Receives reassigned benefits from 12 practitioners
Practice locations: Henderson, NV; Las Vegas, NV

National Provider Directory

National Provider Directory

Locations

3150 N Tenaya Way
Ste 150
Las Vegas, NV 89128
Phone (702) 240-3198

Practitioners & affiliated clinicians

Practitioners 12

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": "1380240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383004800000",
    "number": "1487081048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 370457",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891370457",
            "telephone_number": "702-453-3799",
            "fax_number": "702-453-5741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3150 N TENAYA WAY",
            "address_2": "SUITE 510",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280443",
            "telephone_number": "702-453-3799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAMLOO BLUE SKY TREATMENT CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-27",
        "last_updated": "2013-10-29",
        "status": "A",
        "authorized_official_last_name": "LABRECQUE",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "ACCTS. MGR",
        "authorized_official_telephone_number": "702-453-3799"
    },
    "taxonomies": [
        {
            "code": "207RX0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "NV",
            "license": "13639",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NV LIC",
            "identifier": "13639",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Oct 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.