Provider Demographics
NPI:1013637800
Name:THE DOC'S PRIMARY CARE, INC
Entity type:Organization
Organization Name:THE DOC'S PRIMARY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOVEREAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-630-3205
Mailing Address - Street 1:3005 W HORIZON RIDGE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5030
Mailing Address - Country:US
Mailing Address - Phone:702-997-7600
Mailing Address - Fax:
Practice Address - Street 1:3005 W HORIZON RIDGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5030
Practice Address - Country:US
Practice Address - Phone:702-997-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care