BENLIRO TAKE CARE HEALTH NEVADA PC (TAKE CARE HEALTH NEVADA) - NPI NUMBER 1912103706

Summary

Provider Name: BENLIRO TAKE CARE HEALTH NEVADA PC (TAKE CARE HEALTH NEVADA)

NPI Number: 1912103706

Clasification: Nurse Practitioner (363LF0000X)

Specialization: Family

Address:
4905 W TROPICANA AVE
LAS VEGAS, NV
ZIP 89103

Phone Number: (866) 825-3227



Detailed Information

BENLIRO TAKE CARE HEALTH NEVADA PC is a family nurse practitioner in Las Vegas, NV. The assigned NPI number for this provider is 1912103706 and is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Take Care Health Nevada.

The provider's business address is:

4905 W TROPICANA AVE
LAS VEGAS, NV
ZIP 89103-077
Phone: (866) 825-3227

The provider's authorized official is Jennifer Phipps .
The authorized official title is Chief Financial Official and has the following contact phone number (866) 825-3227.

The enumeration date for this NPI number is 6/27/2007 and was last updated on 11/21/2014.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 363LF0000X Nurse Practitioner Family Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 191210370 MEDICAID NV
2 V104669 MEDICARE PIN NV

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1912103706 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name BENLIRO TAKE CARE HEALTH NEVADA PC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name TAKE CARE HEALTH NEVADA Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 3 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 4905 W TROPICANA AVE The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Business Practice Location Address City Name LAS VEGAS The city name in the location address of the provider being identified.
9 Provider Business Practice Location Address State Name NV The State code in the location of the provider being identified.
10 Provider Business Practice Location Address Postal Code 891035077 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
11 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
12 Provider Business Practice Location Address Telephone Number 8668253227 The telephone number associated with the location address of the provider being identified.
13 Provider Enumeration Date 6/27/2007 The date the provider was assigned a unique identifier (assigned an NPI).
14 Last Update Date 11/21/2014 The date that a record was last updated or changed.
15 Authorized Official Last Name PHIPPS The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
16 Authorized Official First Name JENNIFER The first name of the authorized official.
17 Authorized Official Title or Position CHIEF FINANCIAL OFFICIAL The title or position of the authorized official.
18 Authorized Official Telephone Number 8668253227 The 10-position telephone number of the authorized official.
19 Healthcare Provider Taxonomy Code 1 363LF0000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
20 Healthcare Provider Primary Taxonomy Switch 1 Y
21 Other Provider Identifier 1 191210370 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
22 Other Provider Identifier Type Code 1 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
23 Other Provider Identifier State 1 NV
24 Other Provider Identifier 2 V104669 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
25 Other Provider Identifier Type Code 2 08 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
26 Other Provider Identifier State 2 NV
27 Is Organization Subpart N
28 Healthcare Provider Taxonomy Group 1 193200000X MULTI-SPECIALTY GROUP

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This page was last updated on: 4/19/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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