Provider Demographics
NPI:1699502344
Name:PRIMARY CARE OF SOUTHER NEVADA LLC
Entity type:Organization
Organization Name:PRIMARY CARE OF SOUTHER NEVADA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARAPET
Authorized Official - Middle Name:
Authorized Official - Last Name:AYVAZYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-703-8008
Mailing Address - Street 1:1681 E FLAMINGO RD STE 1B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5274
Mailing Address - Country:US
Mailing Address - Phone:702-703-8008
Mailing Address - Fax:
Practice Address - Street 1:1681 E FLAMINGO RD STE 1B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5274
Practice Address - Country:US
Practice Address - Phone:702-703-8008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center