Box Canyon Primary Care | |
2647 Box Canyon Dr Las Vegas NV 89128-0450 | |
(702) 363-5575 | |
(702) 646-1727 |
Full Name | Box Canyon Primary Care |
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Speciality | Clinic/Center |
Location | 2647 Box Canyon Dr, Las Vegas, Nevada |
Authorized Official Name and Position | Ashley Nuss (BILLER/CODER) |
Authorized Official Contact | 7023635575 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Box Canyon Primary Care 2647 Box Canyon Dr Las Vegas NV 89128-0450 Ph: (702) 363-5575 | Box Canyon Primary Care 2647 Box Canyon Dr Las Vegas NV 89128-0450 Ph: (702) 363-5575 |
NPI Number | 1023287695 |
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Provider Enumeration Date | 02/27/2008 |
Last Update Date | 08/31/2021 |
Medicare PECOS PAC ID | 1557387636 |
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Medicare Enrollment ID | O20051018000785 |
Identifier | Type | State | Issuer |
---|---|---|---|
1023287695 | NPI | - | NPPES |
V101524 | Other | NV | MEDICARE GROUP # |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | 8797 (Nevada) | Primary |
Provider Name | Robert S Roth |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1306843883 PECOS PAC ID: 6800812983 Enrollment ID: I20051216000693 |
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