Provider Demographics
NPI:1497940514
Name:PRO CARE MEDICAL OF LAS VEGAS
Entity Type:Organization
Organization Name:PRO CARE MEDICAL OF LAS VEGAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HOLTZCLAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-740-4138
Mailing Address - Street 1:4420 ARVILLE ST
Mailing Address - Street 2:SUITE #39
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-3742
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4420 ARVILLE ST
Practice Address - Street 2:SUITE #39
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3742
Practice Address - Country:US
Practice Address - Phone:702-740-4138
Practice Address - Fax:702-740-4153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV6023100001Medicare NSC