MEDICARE: NCC HOUSE CALLS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	363A00000X	Physician Assistant
3	363L00000X	Nurse Practitioner
4	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659721140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NCC HOUSE CALLS LLC

Provider Business Mailing Address
First Line	:	9975 S EASTERN AVE STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-7950
Country	:	US
Telephone Number	:	702-659-9090
Fax Number	:	866-879-7229

Provider Business Practice Location Address
First Line	:	9975 S EASTERN AVE
Second Line	:	SUITE 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-7949
Country	:	US
Telephone Number	:	702-492-7208
Fax Number	:	702-616-0657

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CRAIG M JORGENSON
Credential	:	MD
Telephone Number	:	702-279-6977

Provider Enumeration Date	:	06/15/2016
Last Update Date	:	04/28/2023

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Directions to “NCC HOUSE CALLS LLC ” Practice Location

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