Brock Lamont Vance, PA-C
Individual provider Active NPI Medical Physician Assistant · West Wendover, NV
NPI 1003512245 · NPPES record last updated Jan 2, 2025
Key facts
- NPI
- 1003512245
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- PA2775 (NV)
- Practice address
- 925 Wells Avenue
West Wendover, NV 89883 - Phone
- (775) 664-2220
- Fax
- (775) 664-2965
- NPI assigned
- Jan 31, 2023
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NV
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230329002269 | NV | Practitioner - Physician Assistant | 8628442852 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nevada Health Centers Inc | Current |
Accepting new patients |
Locations
3325 Research Way
Carson City, NV 89706
Phone (775) 887-5140
762 14th St
Elko, NV 89801
Phone (775) 738-5850
Interoperability endpoints
- brock.vance.p1@direct.nevadahealthcenters.nextgenshare.com
- bvance695200@direct.ochin.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA2775 | NV | Yes |
Addresses
Primary practice location
925 Wells Avenue
West Wendover, NV 89883
Mailing address
PO Box 2734
West Wendover, NV 89883-2734
Other providers in West Wendover, NV
- Pioneer Medical Supplies LLC
- Prime Medical Supplies LLC
- Rehab & Industrial Services
- Esteban Reyna
- Christy Gene Somsen
All providers in West Wendover, NV · Medical Physician Assistant in Nevada
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 2, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.