| Clark County Medical Group Llc | |
|
3650 S Eastern Ave Ste 330 Las Vegas NV 89169-3345 | |
| (702) 524-9599 | |
| Not Available |
| Full Name | Clark County Medical Group Llc |
|---|---|
| Speciality | General Practice |
| Location | 3650 S Eastern Ave Ste 330, Las Vegas, Nevada |
| Authorized Official Name and Position | Elsie C Dalope (CEO) |
| Authorized Official Contact | 7252045221 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clark County Medical Group Llc 3650 S Eastern Ave Ste 330 Las Vegas NV 89169-3345 Ph: (702) 524-9599 | Clark County Medical Group Llc 3650 S Eastern Ave Ste 330 Las Vegas NV 89169-3345 Ph: (702) 524-9599 |
| NPI Number | 1871094862 |
|---|---|
| Provider Enumeration Date | 02/24/2018 |
| Last Update Date | 04/07/2023 |
| Certification Date | 04/07/2023 |
| Medicare PECOS PAC ID | 4082976394 |
|---|---|
| Medicare Enrollment ID | O20180327001213 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871094862 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (Nevada) | Secondary |
| 208D00000X | General Practice | (Nevada) | Primary |
| 363L00000X | Nurse Practitioner | (Nevada) | Secondary |
| Provider Name | Ireneo L Guiking |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497328850 PECOS PAC ID: 3577738566 Enrollment ID: I20220208002046 |
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