| Community Outreach Medical Center | |
|
1090 E Desert Inn Rd Ste 200 Las Vegas NV 89109-2803 | |
| (702) 657-3873 | |
| (702) 636-0787 |
| Full Name | Community Outreach Medical Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1090 E Desert Inn Rd Ste 200, Las Vegas, Nevada |
| Authorized Official Name and Position | Kema Ogden (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7026573873 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Outreach Medical Center 1090 E Desert Inn Rd Ste 200 Las Vegas NV 89109-2803 Ph: (702) 657-3873 | Community Outreach Medical Center 1090 E Desert Inn Rd Ste 200 Las Vegas NV 89109-2803 Ph: (702) 657-3873 |
| NPI Number | 1073721361 |
|---|---|
| Provider Enumeration Date | 05/18/2007 |
| Last Update Date | 03/29/2021 |
| Medicare PECOS PAC ID | 9830412634 |
|---|---|
| Medicare Enrollment ID | O20141231002003 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073721361 | NPI | - | NPPES |
| 002018167 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | 8907 (Nevada) | Primary |
| Provider Name | Jerry L Cade |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346311354 PECOS PAC ID: 2264458298 Enrollment ID: I20051019000861 |
| Provider Name | Achamma S Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164655536 PECOS PAC ID: 5092122515 Enrollment ID: I20210330002036 |
| Provider Name | Michele Wijangco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245833151 PECOS PAC ID: 7517366016 Enrollment ID: I20210603002406 |
| Provider Name | Denise Cuellar Cook |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083324875 PECOS PAC ID: 7012388432 Enrollment ID: I20230123002485 |
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