Provider Demographics
NPI:1669368353
Name:OUTLIVE CONCIERGE MEDCINE
Entity type:Organization
Organization Name:OUTLIVE CONCIERGE MEDCINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEEP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-209-3255
Mailing Address - Street 1:12242 NASINO AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-1132
Mailing Address - Country:US
Mailing Address - Phone:267-209-3255
Mailing Address - Fax:
Practice Address - Street 1:12242 NASINO AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89138-1132
Practice Address - Country:US
Practice Address - Phone:267-209-3255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care