NPIMap

Organization Active NPI

Complete Family Care Center, LLC

  • Family Medicine Physician
  • Henderson, NV
National Provider Identifier
1104270677
Registry record updated Apr 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
973DL Issued in NV
Legal business name
COMPLETE FAMILY CARE CENTER, LLC
Practice address
600 Whitney Ranch Dr
Suite #B-11
Henderson, NV 89014-2611
Phone
(702) 558-6366
Fax
(702) 558-6364
NPI assigned
Apr 20, 2016
Last updated
Apr 20, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Marc Davis Taylor
Title
Cfo
Phone
(212) 444-5218

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 973DL NV
Family Medicine Physician 207Q00000X 973DL NV Primary

Addresses

Primary practice location

600 Whitney Ranch Dr
Suite #B-11
Henderson, NV 89014-2611

Mailing address

600 Whitney Ranch Dr
Suite #B-11
Henderson, NV 89014-2611
Phone (702) 558-6366

Other identifiers 2

IdentifierTypeStateIssuer
1558317354MedicaidNV
973DLOtherNVMEDICAL LIC

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1461110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461110400000",
    "number": "1104270677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 WHITNEY RANCH DR",
            "address_2": "SUITE #B-11",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890142611",
            "telephone_number": "702-558-6366",
            "fax_number": "702-558-6364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 WHITNEY RANCH DR",
            "address_2": "SUITE #B-11",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890142611",
            "telephone_number": "702-558-6366",
            "fax_number": "702-558-6364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE FAMILY CARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-20",
        "last_updated": "2016-04-20",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "MARC",
        "authorized_official_middle_name": "DAVIS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "212-444-5218",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NV",
            "license": "973DL",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "973DL",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1558317354",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LIC",
            "identifier": "973DL",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.