NPIMap

Organization Active NPI

Safe Harbor Medical, Inc.

  • Family Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1619394251
Registry record updated Mar 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
380 Issued in NV
Legal business name
SAFE HARBOR MEDICAL, INC.
Practice address
2901 N Tenaya Way Ste 100
Las Vegas, NV 89128-1404
Phone
(702) 870-8852
Fax
(702) 870-8914
NPI assigned
Mar 20, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2024

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

Authorized official

Name
Tina A Alicea
Title
Ceo
Phone
(702) 870-8852

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 380 NV Primary
Community Health Clinic/Center 261QC1500X
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

2901 N Tenaya Way Ste 100
Las Vegas, NV 89128-1404

Mailing address

2901 N Tenaya Way Ste 100
Las Vegas, NV 89128-1404
Phone (702) 870-8852

Other names 1

  • Safe Harbor Medical Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Safe Harbor Medical Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

8440 W Lake Mead Blvd
Ste 103
Las Vegas, NV 89128
Phone (702) 870-8852

NPI Registry JSON

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

{
    "created_epoch": "1395273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709510400000",
    "number": "1619394251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 N TENAYA WAY STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891281404",
            "telephone_number": "702-870-8852",
            "fax_number": "702-870-8914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 N TENAYA WAY STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891281404",
            "telephone_number": "702-870-8852",
            "fax_number": "702-870-8914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFE HARBOR MEDICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-20",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A",
        "authorized_official_last_name": "ALICEA",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "702-870-8852"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "380",
            "primary": true
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Safe Harbor Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2024; 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.