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

Summary

Provider Name: DICARLO 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

DICARLO 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 Jeffrey J. Petrick .
The authorized official title is Chief Financial Officer and has the following contact phone number (484) 351-3220.

The enumeration date for this NPI number is 6/27/2007 and was last updated on 9/13/2012.

Map - Location of Practice

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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
1 NPI 1912103706
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name DICARLO TAKE CARE HEALTH NEVADA PC
5 Provider Other Organization Name TAKE CARE HEALTH NEVADA
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 4905 W TROPICANA AVE
8 Provider Business Practice Location Address City Name LAS VEGAS
9 Provider Business Practice Location Address State Name NV
10 Provider Business Practice Location Address Postal Code 891035077
11 Provider Business Practice Location Address Country Code If outside U S US
12 Provider Business Practice Location Address Telephone Number 8668253227
13 Provider Enumeration Date 6/27/2007
14 Last Update Date 9/13/2012
15 Authorized Official Last Name PETRICK
16 Authorized Official First Name JEFFREY
17 Authorized Official Middle Name J.
18 Authorized Official Title or Position CHIEF FINANCIAL OFFICER
19 Authorized Official Telephone Number 4843513220
20 Healthcare Provider Taxonomy Code 1 363LF0000X
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Other Provider Identifier 1 191210370
23 Other Provider Identifier Type Code 1 05
24 Other Provider Identifier State 1 NV
25 Other Provider Identifier 2 V104669
26 Other Provider Identifier Type Code 2 08
27 Other Provider Identifier State 2 NV
28 Is Organization Subpart N
29 Healthcare Provider Taxonomy Group 1 193200000X MULTI-SPECIALTY GROUP

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This page was last updated on: 3/11/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.