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NPI Code Detail

MEDICARE: PROCARE MEDICAL GROUP LLC

MEDICARE: PROCARE MEDICAL GROUP 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
1207Q00000XFamily Medicine Physician12502NV
2261QU0200XUrgent Care Clinic/Center
3261QU0200XUrgent Care Clinic/Center12502NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
112502OTHERNVLICENSE NUMBER

General Provider Information

NPI Number : 1366618019
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROCARE MEDICAL GROUP LLC
Provider Business Mailing Address
First Line : 6870 S RAINBOW BLVD
Second Line : SUITE 106 & 107
City : LAS VEGAS
State : NV
Zip : 89118-2106
Country : US
Telephone Number : 702-396-6000
Fax Number : 702-396-6001
Provider Business Practice Location Address
First Line : 6870 S RAINBOW BLVD
Second Line : SUITE 106 & 107
City : LAS VEGAS
State : NV
Zip : 89118-2106
Country : US
Telephone Number : 702-396-6000
Fax Number : 702-396-6001
Authorized Official
Title or Position : PRACTICE ADMINISTRATOR
Name : AMBER GANTZ
Credential :
Telephone Number : 702-396-6000
Provider Enumeration Date : 05/02/2008
Last Update Date : 03/07/2023

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Directions to “PROCARE MEDICAL GROUP LLC ” Practice Location

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