Provider Demographics
NPI:1508630542
Name:MED-CARE PROVIDERS LLC
Entity type:Organization
Organization Name:MED-CARE PROVIDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:OSMEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLAREAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-444-1002
Mailing Address - Street 1:1515 E TROPICANA AVE STE 345-A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6517
Mailing Address - Country:US
Mailing Address - Phone:702-444-1002
Mailing Address - Fax:
Practice Address - Street 1:4525 S SANDHILL RD STE 103
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5955
Practice Address - Country:US
Practice Address - Phone:702-444-1002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-09
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty