NPI |
1306462742 |
The date that a record was last updated or changed. |
Entity Type Code |
2 |
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. |
Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider Organization Name Legal Business Name |
TOTAL CARE MEDICAL GROUP LLC |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider First Line Business Practice Location Address |
6040 S DURANGO DR STE 115 |
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. |
Provider Business Practice Location Address City Name |
LAS VEGAS |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Provider Business Practice Location Address State Name |
NV |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
891131792 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
3104088714 |
The telephone number associated with the location address of the provider being identified. |
Provider Enumeration Date |
6/22/2020 |
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. |
Last Update Date |
6/22/2020 |
The date that a record was last updated or changed. |
Authorized Official Last Name |
DOBLE |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Authorized Official First Name |
JOHN |
The first name of the authorized official. |
Authorized Official Title or Position |
ADMINISTRATOR |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Authorized Official Telephone Number |
3104088714 |
|
Healthcare Provider Taxonomy Code 1 |
363L00000X |
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. |
Healthcare Provider Primary Taxonomy Switch 1 |
N |
|
Healthcare Provider Taxonomy Code 2 |
208D00000X |
|
Healthcare Provider Primary Taxonomy Switch 2 |
Y |
|
Is Organization Subpart |
N |
|
Healthcare Provider Taxonomy Group 1 |
193400000X MULTIPLE SINGLE SPECIALTY GROUP |
|
Healthcare Provider Taxonomy Group 2 |
193400000X MULTIPLE SINGLE SPECIALTY GROUP |
|
NPI Certification Date |
6/22/2020 |
|