MEDICARE: COMMUNITY OUTREACH MEDICAL CENTER

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	261QC1500X	Community Health Clinic/Center	8907	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073721361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY OUTREACH MEDICAL CENTER

Provider Business Mailing Address
First Line	:	1090 E DESERT INN RD STE 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-2803
Country	:	US
Telephone Number	:	702-657-3873
Fax Number	:	702-636-0787

Provider Business Practice Location Address
First Line	:	1090 E DESERT INN RD STE 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-2803
Country	:	US
Telephone Number	:	702-657-3873
Fax Number	:	702-636-0787

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. KEMA OGDEN
Credential	:
Telephone Number	:	702-657-3873

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	03/29/2021

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Directions to “COMMUNITY OUTREACH MEDICAL CENTER ” Practice Location

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