MEDICARE: CLARK COUNTY 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 State
1	103K00000X	Behavior Analyst	NV
2	363L00000X	Nurse Practitioner	NV
3	208D00000X	General Practice Physician	NV

General Provider Information

NPI Number	:	1871094862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARK COUNTY MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	3650 S EASTERN AVE STE 330
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3345
Country	:	US
Telephone Number	:	702-524-9599
Fax Number	:

Provider Business Practice Location Address
First Line	:	3650 S EASTERN AVE STE 330
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3345
Country	:	US
Telephone Number	:	702-524-9599
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ELSIE C DALOPE
Credential	:
Telephone Number	:	725-204-5221

Provider Enumeration Date	:	02/24/2018
Last Update Date	:	08/30/2025

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Directions to “CLARK COUNTY MEDICAL GROUP LLC ” Practice Location

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