MEDICARE: VERTEX PRIMARY CARE NEVADA 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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1982366803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERTEX PRIMARY CARE NEVADA LLC

Provider Business Mailing Address
First Line	:	PO BOX 1810
Second Line	:
City	:	SPANISH FORK
State	:	UT
Zip	:	84660-7810
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9525 HILLWOOD DR STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-0596
Country	:	US
Telephone Number	:	385-200-1097
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KINDRA WOODRUFF
Credential	:
Telephone Number	:	801-210-0659

Provider Enumeration Date	:	10/07/2021
Last Update Date	:	10/07/2021

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