MEDICARE: PRIMARY CARE HEALTH INC.

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1518512318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY CARE HEALTH INC.

Provider Business Mailing Address
First Line	:	1312 PAGENTRY DR
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89031-2340
Country	:	US
Telephone Number	:	702-528-9947
Fax Number	:	702-522-1606

Provider Business Practice Location Address
First Line	:	4375 LAS VEGAS BLVD N STE 9
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-0587
Country	:	US
Telephone Number	:	702-450-1717
Fax Number	:	702-522-1606

Authorized Official
Title or Position	:	CEO
Name	:	MRS. KRISTA HUEY
Credential	:	BSHCA
Telephone Number	:	702-528-9947

Provider Enumeration Date	:	08/08/2019
Last Update Date	:	08/08/2019

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