1St Clark County Medical Clinic LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

1ST CLARK COUNTY MEDICAL CLINIC LLC

Practice address

4570 S Eastern Ave Ste 26
Las Vegas, NV 89119-6183

Phone

(702) 476-3345

Fax

(702) 920-8596

NPI assigned

Mar 13, 2023

Last updated

Sep 30, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Grezilda Mae Cabo

Title

Ceo

Phone

(702) 445-1196

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ellaine Manabat, MSN, APRN, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Las Vegas, NV
  • NPI 1689484412
  Medicare reassignment NPD
• Annette Kee, APRN PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Las Vegas, NV
  • NPI 1710248505
  Medicare reassignment
• Linda W Sims, MSW LCSW LADC

  • Mental Health Counselor
  • North Las Vegas, NV
  • NPI 1427141738
  Medicare reassignment
• Stephen L Tam, MD

  • Internal Medicine Physician
  • Las Vegas, NV
  • NPI 1689738478
  Medicare reassignment

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

{
    "created_epoch": "1678665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790726400000",
    "number": "1154022523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4570 S EASTERN AVE STE 26",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891196183",
            "telephone_number": "702-445-1196",
            "fax_number": "702-920-8596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4570 S EASTERN AVE STE 26",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891196183",
            "telephone_number": "702-476-3345",
            "fax_number": "702-920-8596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1ST CLARK COUNTY MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-13",
        "last_updated": "2026-09-30",
        "certification_date": "2026-09-30",
        "status": "A",
        "authorized_official_last_name": "CABO",
        "authorized_official_first_name": "GREZILDA MAE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "702-445-1196"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2084B0040X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• General Practice Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.