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Contact Information

PROVENANCE HEALTHCARE LLC
5155 S DURANGO DR STE 103
LAS VEGAS, NV89113-0175
 Phone: 702-478-2524
 Fax: 702-735-9074
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Genetic Counselor, MS

170300000X
Indicates primary specialty

NPI Profile & details for PROVENANCE HEALTHCARE LLC

NPI Number 1316322738
LBN Legal business name PROVENANCE HEALTHCARE LLC
Authorized official MARK BLACK - (OWNER OPERATOR)
Entity Organization
Organization subpart 1 No
Enumeration date 07/27/2015
Last updated 07/27/2015 - About 11 years ago
Identifiers
NV License # OTHER
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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