| Pain Management Depot Inc | |
|
811 S Decatur Blvd Las Vegas NV 89107-3933 | |
| (702) 808-6501 | |
| (702) 685-8450 |
| Full Name | Pain Management Depot Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 811 S Decatur Blvd, Las Vegas, Nevada |
| Authorized Official Name and Position | Franklin Akioyame (OWNER) |
| Authorized Official Contact | 7029923563 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pain Management Depot Inc 2465 Reynolds Ave Ste 301 N Las Vegas NV 89030-7296 Ph: (702) 992-3563 | Pain Management Depot Inc 811 S Decatur Blvd Las Vegas NV 89107-3933 Ph: (702) 808-6501 |
| NPI Number | 1841810686 |
|---|---|
| Provider Enumeration Date | 04/22/2020 |
| Last Update Date | 12/15/2021 |
| Medicare PECOS PAC ID | 7214328913 |
|---|---|
| Medicare Enrollment ID | O20220106000295 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841810686 | NPI | - | NPPES |
| 2600379066 | Other | NV | DRIVERS LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Franklin Akioyame |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982863882 PECOS PAC ID: 7012089832 Enrollment ID: I20080710000349 |
| Provider Name | Marilyn J Tuiasosopo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629733704 PECOS PAC ID: 3476930231 Enrollment ID: I20220517000511 |
| Provider Name | Terry Flores |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770983678 PECOS PAC ID: 5799163986 Enrollment ID: I20220531001075 |
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