NPIMap

Organization Active NPI

East Charelston Pain Clinic and Medical Center

  • Family Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1649512880
Registry record updated Mar 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
EAST CHARELSTON PAIN CLINIC AND MEDICAL CENTER
Practice address
1721 E Charleston Blvd
Las Vegas, NV 89104-1902
Phone
(702) 515-9680
NPI assigned
Mar 26, 2013
Organization subpart
Yes
Parent organization
EBONNY VENTURES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 26, 2013

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

Authorized official

Name
Festus Ebonka
Title
President
Phone
(702) 515-9680

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0000X

Addresses

Primary practice location

1721 E Charleston Blvd
Las Vegas, NV 89104-1902

Mailing address

1721 E Charleston Blvd
Las Vegas, NV 89104-1902

National Provider Directory

National Provider Directory
Tax ID family
East Charleston Mental Health Clinc and Counseling2 organizations share this tax ID, including this one
Part of
East Charleston Mental Health Clinc and Counseling

Other organizations with this tax ID 1

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": "1364256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364256000000",
    "number": "1649512880",
    "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"
        },
        {
            "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": "702-515-9680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST CHARELSTON PAIN CLINIC AND MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EBONNY VENTURES INC",
        "enumeration_date": "2013-03-26",
        "last_updated": "2013-03-26",
        "status": "A",
        "authorized_official_last_name": "EBONKA",
        "authorized_official_first_name": "FESTUS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "702-515-9680"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Mar 26, 2013; 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.