Primary Care of Southern Nevada

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

PRIMARY CARE OF SOUTHERN NEVADA

Practice address

2225 Village Walk Dr
Suite 270
Henderson, NV 89052-5679

Phone

(702) 993-0333

Fax

(702) 990-0336

NPI assigned

Jun 29, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Kelly Elan Van Wagner, M.D.

Title

Owner

Phone

(702) 990-0333

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193097600000",
    "number": "1821026824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2225 VILLAGE WALK DR",
            "address_2": "SUITE 270",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890525679",
            "telephone_number": "702-993-0333",
            "fax_number": "702-990-0336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2225 VILLAGE WALK DR",
            "address_2": "SUITE 270",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890525679",
            "telephone_number": "702-993-0333",
            "fax_number": "702-990-0336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE OF SOUTHERN NEVADA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-29",
        "last_updated": "2007-10-23",
        "status": "A",
        "authorized_official_last_name": "VAN WAGNER",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "ELAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-990-0333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Henderson, NV
• Providers in Henderson, NV by specialty
• Internal Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2007; 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.