Healthcare Provider Details

I. General information

NPI: 1750479614
Provider Name (Legal Business Name): PHC OF NEVADA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 W CHARLESTON BLVD SUITE 300
LAS VEGAS NV
89102
US

IV. Provider business mailing address

1701 W CHARLESTON BLVD SUITE 300
LAS VEGAS NV
89102
US

V. Phone/Fax

Practice location:
  • Phone: 702-251-8000
  • Fax: 702-471-0120
Mailing address:
  • Phone: 702-251-8000
  • Fax: 702-471-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number163235
License Number StateNV

VIII. Authorized Official

Name: MR. ALLEN B FLAGG JR.
Title or Position: VICE PRESIDENT WESTERN REGIONAL OPE
Credential:
Phone: 702-251-8000