MEDICARE: HEALTH CARE CENTER OF SOUTHERN NEVADA

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	207QA0505X	Adult Medicine Physician	54847	NV
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	54847	NV

General Provider Information

NPI Number	:	1639280118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH CARE CENTER OF SOUTHERN NEVADA

Provider Business Mailing Address
First Line	:	PO BOX 97075
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89193-7075
Country	:	US
Telephone Number	:	702-314-2400
Fax Number	:	702-314-2405

Provider Business Practice Location Address
First Line	:	2842 E LAKE MEAD BLVD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-6548
Country	:	US
Telephone Number	:	702-314-2400
Fax Number	:	702-314-2405

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. NONG SABIO
Credential	:
Telephone Number	:	702-314-2400

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	09/11/2025

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