Van Wagner Immediate Care Center

Primary specialty

Urgent Care Clinic/CenterTaxonomy code 261QU0200X

License

9533 Issued in NV

Legal business name

VAN WAGNER IMMEDIATE CARE CENTER

Practice address

2360 Corporate Cir
Suite 100
Henderson, NV 89074-7722

Phone

(702) 990-0333

Fax

(702) 990-0336

NPI assigned

Sep 30, 2008

Organization subpart

Yes

Parent organization

VAN WAGNER HEALTHCARE MANAGEMENTAs reported in NPPES

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

Authorized official

Name

Dr. Kelly Elan Van Wagner, M.D.NPI 1306035571

Title

Owner

Phone

(702) 990-0333

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Kelly E Van Wagner, M.D.

  • Internal Medicine Physician
  • N Las Vegas, NV
  • NPI 1306035571
  NPD (past) Authorized official

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

{
    "created_epoch": "1222732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222819200000",
    "number": "1790936458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2225 VILLAGE WALK DR",
            "address_2": "SUITE 270",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890525679",
            "telephone_number": "702-990-0333",
            "fax_number": "702-990-0336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2360 CORPORATE CIR",
            "address_2": "SUITE 100",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890747722",
            "telephone_number": "702-990-0333",
            "fax_number": "702-990-0336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VAN WAGNER IMMEDIATE CARE CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VAN WAGNER HEALTHCARE MANAGEMENT",
        "enumeration_date": "2008-09-30",
        "last_updated": "2008-10-01",
        "status": "A",
        "authorized_official_last_name": "VAN WAGNER",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "ELAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-990-0333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NV",
            "license": "9533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cheryl Van Meter
• Dillan Van Ness
• Heather Van Ness
• Ny Van Steenkiste
• Sara Van Wagenen
• Ythu Michael Van
• James Ryan Vanburen, APRN
• Jasmine Cornell Vance
• Jason T Vanlue, DMD
• Jonathan Vann

• Urgent Care Clinic/Center in Henderson, NV
• Providers in Henderson, NV by specialty
• Urgent Care Clinic/Center in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2008; 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.