Provider Demographics
NPI:1750990503
Name:NEVADA PRIME CARE LLC
Entity type:Organization
Organization Name:NEVADA PRIME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARIAGNE ARIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-588-1938
Mailing Address - Street 1:3430 E FLAMINGO RD STE 311
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5067
Mailing Address - Country:US
Mailing Address - Phone:702-324-9092
Mailing Address - Fax:
Practice Address - Street 1:3340 TOPAZ ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3903
Practice Address - Country:US
Practice Address - Phone:702-588-1938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty