Basic Information
| Provider Information | |||||||||
| NPI: | 1902117245 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SEP BADY LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2149 | ||||||||
| Address2: | |||||||||
| City: | PAHRUMP | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890412149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107095494 | ||||||||
| FaxNumber: | 7757275689 | ||||||||
| Practice Location | |||||||||
| Address1: | 5400 S RAINBOW BLVD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891181859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107095494 | ||||||||
| FaxNumber: | 7757275689 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2010 | ||||||||
| LastUpdateDate: | 07/01/2010 | ||||||||
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| AuthorizedOfficialLastName: | BADY | ||||||||
| AuthorizedOfficialFirstName: | SEP | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3107095494 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 13004 | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.