Provider Demographics
NPI:1639280118
Name:HEALTH CARE CENTER OF SOUTHERN NEVADA
Entity type:Organization
Organization Name:HEALTH CARE CENTER OF SOUTHERN NEVADA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:NONG
Authorized Official - Middle Name:
Authorized Official - Last Name:SABIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-314-2400
Mailing Address - Street 1:PO BOX 97075
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-7075
Mailing Address - Country:US
Mailing Address - Phone:702-314-2400
Mailing Address - Fax:702-314-2405
Practice Address - Street 1:2842 E LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-6548
Practice Address - Country:US
Practice Address - Phone:702-314-2400
Practice Address - Fax:702-314-2405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV54847207QA0505X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Not Answered207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV=========OtherTAX ID
NVV35429Medicare ID - Type UnspecifiedGROUP IDENTIFIER