MEDICARE: VALLEY PRIMARY CARE CENTER 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	207R00000X	Internal Medicine Physician
2	261QP2300X	Primary Care Clinic/Center	8444	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568659381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY PRIMARY CARE CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 400548
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89140-0548
Country	:	US
Telephone Number	:	702-921-6829
Fax Number	:	702-921-6828

Provider Business Practice Location Address
First Line	:	6867 W CHARLESTON BLVD STE B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1669
Country	:	US
Telephone Number	:	702-921-6823
Fax Number	:	702-252-4405

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	RITU D JOSHI
Credential	:	M.D.
Telephone Number	:	702-382-6100

Provider Enumeration Date	:	09/25/2007
Last Update Date	:	11/22/2021

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