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NPI Code Detail

MEDICARE: PRIME CARDIOLOGY GROUP

MEDICARE: PRIME CARDIOLOGY GROUP
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
1207RC0000XCardiovascular Disease Physician
2207RI0011XInterventional Cardiology Physician
3207RC0001XClinical Cardiac Electrophysiology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111289OTHERNVNEVADA MEDICAL LICENSE
2NV20201689839OTHERNVNEVADA STATE BUSINESS LICENSE

General Provider Information

NPI Number : 1730710807
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRIME CARDIOLOGY GROUP
Provider Business Mailing Address
First Line : 2855 SAINT ROSE PKWY STE 110
Second Line :
City : HENDERSON
State : NV
Zip : 89052-4812
Country : US
Telephone Number : 702-805-5678
Fax Number : 725-204-0423
Provider Business Practice Location Address
First Line : 9950 W CHEYENNE AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-7700
Country : US
Telephone Number : 702-805-5678
Fax Number : 725-204-0423
Authorized Official
Title or Position : SR. CREDENTIALING SPECIALIST
Name : MELONIE SINCLAIR
Credential :
Telephone Number : 281-673-7752
Provider Enumeration Date : 01/28/2020
Last Update Date : 03/10/2026

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Directions to “PRIME CARDIOLOGY GROUP ” Practice Location

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