MEDICARE: TOTAL CARE 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	License Number State
1	363L00000X	Nurse Practitioner
2	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1306462742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL CARE MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	3358 HILLSIDE GARDEN DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-2829
Country	:	US
Telephone Number	:	310-408-8714
Fax Number	:

Provider Business Practice Location Address
First Line	:	6040 S DURANGO DR STE 115
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-1792
Country	:	US
Telephone Number	:	310-408-8714
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JOHN DOBLE
Credential	:
Telephone Number	:	310-408-8714

Provider Enumeration Date	:	06/22/2020
Last Update Date	:	06/22/2020

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