Healthcare Provider Details

I. General information

NPI: 1598481541
Provider Name (Legal Business Name): PURE HEALTHCARE OF NEVADA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 W LAKE MEAD BLVD STE 112
LAS VEGAS NV
89128-8362
US

IV. Provider business mailing address

4179 S RIVERBOAT RD STE 220
TAYLORSVILLE UT
84123-2986
US

V. Phone/Fax

Practice location:
  • Phone: 702-703-5160
  • Fax: 801-327-0211
Mailing address:
  • Phone: 801-590-9267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA T TANDY
Title or Position: OWNER
Credential:
Phone: 801-787-0731