Provider Demographics
NPI: | 1659612547 |
---|---|
Name: | FIRST PERSON CARE CLINIC |
Entity Type: | Organization |
Organization Name: | FIRST PERSON CARE CLINIC |
Other - Org Name: | FIRST PERSON COMPLETE CARE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | ROXANA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | VALETON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 702-380-8118 |
Mailing Address - Street 1: | 1200 S 4TH ST |
Mailing Address - Street 2: | SUITE 111 |
Mailing Address - City: | LAS VEGAS |
Mailing Address - State: | NV |
Mailing Address - Zip Code: | 89104-1046 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 702-380-8118 |
Mailing Address - Fax: | 702-380-2929 |
Practice Address - Street 1: | 1200 S 4TH ST |
Practice Address - Street 2: | SUITE 111 |
Practice Address - City: | LAS VEGAS |
Practice Address - State: | NV |
Practice Address - Zip Code: | 89104-1046 |
Practice Address - Country: | US |
Practice Address - Phone: | 702-277-5827 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-03-03 |
Last Update Date: | 2021-05-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
163WC1500X, 163WI0500X, 207Q00000X, 207RC0000X, 207RI0200X, 207RR0500X, 207VG0400X, 208000000X, 261QF0050X, 261QF0400X, 261QM1300X, 363AM0700X, 363LF0000X, 363LG0600X | ||
NV | 261Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
No | 163WC1500X | Nursing Service Providers | Registered Nurse | Community Health | Group - Multi-Specialty |
No | 163WI0500X | Nursing Service Providers | Registered Nurse | Infusion Therapy | Group - Multi-Specialty |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
No | 207VG0400X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | Group - Multi-Specialty |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | ||
No | 261QF0050X | Ambulatory Health Care Facilities | Clinic/Center | Family Planning, Non-Surgical | |
No | 261QF0400X | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | |
No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
No | 363LG0600X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NV | 1659612547 | Medicaid |