| Safe Harbor Medical | |
|
2901 N Tenaya Way Ste 100 Las Vegas NV 89128-1404 | |
| (702) 870-8852 | |
| (702) 870-8914 |
| Full Name | Safe Harbor Medical |
|---|---|
| Speciality | Family Medicine |
| Location | 2901 N Tenaya Way Ste 100, Las Vegas, Nevada |
| Authorized Official Name and Position | Tina A Alicea (CEO) |
| Authorized Official Contact | 7028708852 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Safe Harbor Medical 2901 N Tenaya Way Ste 100 Las Vegas NV 89128-1404 Ph: (702) 870-8852 | Safe Harbor Medical 2901 N Tenaya Way Ste 100 Las Vegas NV 89128-1404 Ph: (702) 870-8852 |
| NPI Number | 1821290115 |
|---|---|
| Provider Enumeration Date | 05/31/2007 |
| Last Update Date | 10/14/2024 |
| Medicare PECOS PAC ID | 6204903792 |
|---|---|
| Medicare Enrollment ID | O20080925000222 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821290115 | NPI | - | NPPES |
| 250007806 | Medicaid | NV | |
| 2019993 | Medicaid | NV | |
| NPI | Other | NV | 1457320004 |
| 1104478270 | Medicaid | NV | |
| 184105523 | Medicaid | NV | |
| 1841205523 | Medicaid | NV | |
| 100517352 | Medicaid | NV | |
| 1619657996 | Medicaid | NV | |
| NPI | Other | NV | 1932741048 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 113458 (Nevada) | Primary |
| Provider Name | Lawson C Richter |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1457320004 PECOS PAC ID: 0143120121 Enrollment ID: I20040113000685 |
| Provider Name | Michelle Pierson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972082956 PECOS PAC ID: 2163762741 Enrollment ID: I20190318001801 |
| Provider Name | Onyx Michele Reed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932741048 PECOS PAC ID: 4082042015 Enrollment ID: I20200325000822 |
| Provider Name | Judith Aquino Belete |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033819859 PECOS PAC ID: 7113385014 Enrollment ID: I20230626001678 |
| Provider Name | Sheryl L Kaboud |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619657996 PECOS PAC ID: 0042658643 Enrollment ID: I20240402001462 |
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