Provider Demographics
NPI:1073526448
Name:LAS VEGAS HOUSE CALLS LLC
Entity Type:Organization
Organization Name:LAS VEGAS HOUSE CALLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-818-5933
Mailing Address - Street 1:9563 BORGATA BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8014
Mailing Address - Country:US
Mailing Address - Phone:702-818-5933
Mailing Address - Fax:
Practice Address - Street 1:9563 BORGATA BAY BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8014
Practice Address - Country:US
Practice Address - Phone:702-818-5933
Practice Address - Fax:702-818-5934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7359173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV1360OtherANTHEM BCBS NV GROUP
NVNV1360OtherANTHEM BCBS NV GROUP
NVDF1136Medicare ID - Type UnspecifiedRAILROAD MEDICARE