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5119 Camino Al Norte North Las Vegas NV 89031-2373 | |
| (702) 625-8989 | |
| (702) 331-3115 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 5119 Camino Al Norte, North Las Vegas, Nevada |
| Authorized Official Name and Position | Ivy Tan (MANAGER) |
| Authorized Official Contact | 7026258989 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5119 Camino Al Norte Ste 100 N Las Vegas NV 89031-2373 Ph: (702) 625-8989 | 5119 Camino Al Norte North Las Vegas NV 89031-2373 Ph: (702) 625-8989 |
| NPI Number | 1225781636 |
|---|---|
| Provider Enumeration Date | 01/27/2022 |
| Last Update Date | 11/28/2023 |
| Medicare PECOS PAC ID | 3870971583 |
|---|---|
| Medicare Enrollment ID | O20220609000340 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225781636 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| 363LP2300X | Nurse Practitioner - Primary Care | (* (Not Available)) | Secondary |
| Provider Name | George Tan |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1205071677 PECOS PAC ID: 5496891392 Enrollment ID: I20210218002625 |
| Provider Name | Ivy Ying Tan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982833281 PECOS PAC ID: 2668517590 Enrollment ID: I20220609000564 |
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