Basic Information
| Provider Information | |||||||||
| NPI: | 1003011313 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL GROUP AT SUN CITY, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2601 N TENAYA WAY | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891280427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022408155 | ||||||||
| FaxNumber: | 7022408161 | ||||||||
| Practice Location | |||||||||
| Address1: | 2601 N TENAYA WAY | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891280427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022408155 | ||||||||
| FaxNumber: | 7022408161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2007 | ||||||||
| LastUpdateDate: | 09/21/2021 | ||||||||
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| AuthorizedOfficialLastName: | NGUYEN | ||||||||
| AuthorizedOfficialFirstName: | CAROL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2146494686 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100509533 | 05 | NV | MEDICAID |