MEDICARE: LAS VEGAS HOUSE CALLS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173000000X	Legal Medicine	7359	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NV1360	OTHER	NV	ANTHEM BCBS NV GROUP

General Provider Information

NPI Number	:	1073526448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS VEGAS HOUSE CALLS LLC

Provider Business Mailing Address
First Line	:	9563 BORGATA BAY BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-8014
Country	:	US
Telephone Number	:	702-818-5933
Fax Number	:

Provider Business Practice Location Address
First Line	:	9563 BORGATA BAY BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-8014
Country	:	US
Telephone Number	:	702-818-5933
Fax Number	:	702-818-5934

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MONICA K MITCHELL
Credential	:
Telephone Number	:	702-818-5933

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	08/22/2020

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Directions to “LAS VEGAS HOUSE CALLS LLC ” Practice Location

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