Provider Demographics
NPI:1639246309
Name:FREMONT PRIMARY CARE LTD
Entity Type:Organization
Organization Name:FREMONT PRIMARY CARE LTD
Other - Org Name:FREMONT MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:GREG
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:702-671-6800
Mailing Address - Street 1:PO BOX 1737
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89125-1737
Mailing Address - Country:US
Mailing Address - Phone:702-671-6800
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:9280 W SUNSET RD
Practice Address - Street 2:SUITE 418
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4860
Practice Address - Country:US
Practice Address - Phone:702-430-3600
Practice Address - Fax:702-939-8827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty