Healthcare Provider Details

I. General information

NPI: 1659721140
Provider Name (Legal Business Name): NCC HOUSE CALLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 04/28/2023
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9975 S EASTERN AVE SUITE 110
LAS VEGAS NV
89183-7949
US

IV. Provider business mailing address

9975 S EASTERN AVE STE 110
LAS VEGAS NV
89183-7950
US

V. Phone/Fax

Practice location:
  • Phone: 702-492-7208
  • Fax: 702-616-0657
Mailing address:
  • Phone: 702-659-9090
  • Fax: 866-879-7229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CRAIG M JORGENSON
Title or Position: PRESIDENT
Credential: MD
Phone: 702-279-6977