MEDICARE: NEVADA PRIME CARE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	261QM1300X	Multi-Specialty Clinic/Center
3	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1750990503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA PRIME CARE LLC

Provider Business Mailing Address
First Line	:	3430 E FLAMINGO RD STE 311
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5067
Country	:	US
Telephone Number	:	702-324-9092
Fax Number	:

Provider Business Practice Location Address
First Line	:	3340 TOPAZ ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3903
Country	:	US
Telephone Number	:	702-588-1938
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ARIAGNE ARIELLE DUAVE
Credential	:
Telephone Number	:	702-588-1938

Provider Enumeration Date	:	07/28/2020
Last Update Date	:	06/10/2021

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