Basic Information
| Provider Information | |||||||||
| NPI: | 1174757041 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PATIENTS FIRST MEDICAL LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10511 BROADHEAD CT | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7752506161 | ||||||||
| FaxNumber: | 7023825388 | ||||||||
| Practice Location | |||||||||
| Address1: | 10511 BROADHEAD CT | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891352323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7752506161 | ||||||||
| FaxNumber: | 7023825388 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2009 | ||||||||
| LastUpdateDate: | 05/07/2009 | ||||||||
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| AuthorizedOfficialLastName: | HOUSHAN | ||||||||
| AuthorizedOfficialFirstName: | IYAD | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLD MBR | ||||||||
| AuthorizedOfficialTelephone: | 17752506161 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 10568 | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1497773287 | 05 | NV | MEDICAID |