MEDICARE: NEM-CARE 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1194019067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEM-CARE LLC

Provider Business Mailing Address
First Line	:	4440 E WASHINGTON AVE STE 109
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-5793
Country	:	US
Telephone Number	:	702-255-1114
Fax Number	:	702-255-8199

Provider Business Practice Location Address
First Line	:	2670 N LAS VEGAS BLVD STE 109
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89030-5871
Country	:	US
Telephone Number	:	702-399-0604
Fax Number	:	702-399-0607

Authorized Official
Title or Position	:	OWNER
Name	:	EDMOND PATVAKANYAN
Credential	:
Telephone Number	:	702-255-1114

Provider Enumeration Date	:	06/08/2011
Last Update Date	:	06/08/2011

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Directions to “NEM-CARE LLC ” Practice Location

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