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NPI Code Detail

MEDICARE: NLVBH & PRIMARY CARE CENTER

MEDICARE: NLVBH & PRIMARY CARE 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
1101YM0800XMental Health Counselor

Other Identifiers

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

General Provider Information

NPI Number : 1558037002
Entity Type Code : Organization
Provider Name (Legal Business Name) : NLVBH & PRIMARY CARE CENTER
Provider Business Mailing Address
First Line : 3131 W CRAIG RD STE 180
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-0861
Country : US
Telephone Number : 702-469-7897
Fax Number :
Provider Business Practice Location Address
First Line : 3277 W CRAIG RD STE 100-130
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-0792
Country : US
Telephone Number : 702-469-7897
Fax Number :
Authorized Official
Title or Position : CEO
Name : KIRK WAN
Credential :
Telephone Number : 702-469-7897
Provider Enumeration Date : 08/16/2021
Last Update Date : 08/16/2021

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Directions to “NLVBH & PRIMARY CARE CENTER ” Practice Location

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