Provider Demographics
NPI:1598459885
Name:PRIMARY CARE OF NEVADA LLC
Entity Type:Organization
Organization Name:PRIMARY CARE OF NEVADA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:PHUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-401-3632
Mailing Address - Street 1:601 S 10TH ST # 101
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-7027
Mailing Address - Country:US
Mailing Address - Phone:702-401-3632
Mailing Address - Fax:
Practice Address - Street 1:601 S 10TH ST # 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-7027
Practice Address - Country:US
Practice Address - Phone:702-401-3632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty