Provider Demographics
NPI:1568659381
Name:VALLEY PRIMARY CARE CENTER LLC
Entity Type:Organization
Organization Name:VALLEY PRIMARY CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RITU
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-382-6100
Mailing Address - Street 1:PO BOX 400548
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89140-0548
Mailing Address - Country:US
Mailing Address - Phone:702-921-6829
Mailing Address - Fax:702-921-6828
Practice Address - Street 1:6867 W CHARLESTON BLVD STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1669
Practice Address - Country:US
Practice Address - Phone:702-921-6823
Practice Address - Fax:702-252-4405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
NV8444261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100505630Medicaid
NV100505630Medicaid