Provider Demographics
NPI:1316173891
Name:WESTERN CRITICAL CARE ASSOCIATES
Entity type:Organization
Organization Name:WESTERN CRITICAL CARE ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:T
Authorized Official - Last Name:WATANABE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-233-9222
Mailing Address - Street 1:PO BOX 371353
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89137-1353
Mailing Address - Country:US
Mailing Address - Phone:702-233-9222
Mailing Address - Fax:702-685-4246
Practice Address - Street 1:10300 W CHARLESTON BLVD STE 13-342
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-1037
Practice Address - Country:US
Practice Address - Phone:702-233-9222
Practice Address - Fax:702-804-1349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-10
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVBZ399AMedicare PIN