Provider Demographics
NPI:1659721140
Name:NCC HOUSE CALLS LLC
Entity Type:Organization
Organization Name:NCC HOUSE CALLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:M
Authorized Official - Last Name:JORGENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-279-6977
Mailing Address - Street 1:9975 S EASTERN AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-7950
Mailing Address - Country:US
Mailing Address - Phone:702-659-9090
Mailing Address - Fax:866-879-7229
Practice Address - Street 1:9975 S EASTERN AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-7949
Practice Address - Country:US
Practice Address - Phone:702-492-7208
Practice Address - Fax:702-616-0657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1073071932Medicaid
NV1417956848Medicaid
NV1528492907Medicaid
NV1154697126Medicaid
NV1174624142Medicaid
NV1720487598Medicaid
NV1154893881Medicaid
NV1265998736Medicaid
NV1356822282Medicaid