NPIMap

Organization Active NPI

Ortho Sport and Spine Physicians Las Vegas

  • Physical Medicine & Rehabilitation Physician
  • Henderson, NV
National Provider Identifier
1629651096
Registry record updated Jun 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
ORTHO SPORT AND SPINE PHYSICIANS LAS VEGAS
Practice address
2625 Wigwam Pkwy Ste 102
Henderson, NV 89074-7326
Phone
(678) 752-7246
Fax
(770) 234-5326
NPI assigned
May 3, 2021
Last updated
Jun 1, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2023

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

Authorized official

Name
Ra'Keshia Brogdon
Title
Credentialing Specialist
Phone
(404) 941-1233

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X Primary

Addresses

Primary practice location

2625 Wigwam Pkwy Ste 102
Henderson, NV 89074-7326

Mailing address

5788 Roswell Rd
Atlanta, GA 30328-4904
Phone (305) 290-2448

National Provider Directory

National Provider Directory
Tax ID family
Ortho Sport and Spine Physicians Las Vegas35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

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

View all 34

Locations

2526 Wigwam Pkwy
Ste 102
Henderson, NV 89074

NPI Registry JSON

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

{
    "created_epoch": "1620000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685577600000",
    "number": "1629651096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5788 ROSWELL RD",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303284904",
            "telephone_number": "305-290-2448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2625 WIGWAM PKWY STE 102",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890747326",
            "telephone_number": "678-752-7246",
            "fax_number": "770-234-5326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHO SPORT AND SPINE PHYSICIANS LAS VEGAS",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-03",
        "last_updated": "2023-06-01",
        "certification_date": "2023-06-01",
        "status": "A",
        "authorized_official_last_name": "BROGDON",
        "authorized_official_first_name": "RA'KESHIA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "404-941-1233"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2023; 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.