| Fountain Medical Associates | |
|
3599 S Eastern Ave Las Vegas NV 89169-3344 | |
| (702) 522-0701 | |
| (702) 522-0701 |
| Full Name | Fountain Medical Associates |
|---|---|
| Speciality | Clinic/Center |
| Location | 3599 S Eastern Ave, Las Vegas, Nevada |
| Authorized Official Name and Position | Chima Osuoha (PRESIDENT/CEO) |
| Authorized Official Contact | 2052498491 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fountain Medical Associates 3328 Horned Lark Ct Las Vegas NV 89117-7712 Ph: (205) 249-8491 | Fountain Medical Associates 3599 S Eastern Ave Las Vegas NV 89169-3344 Ph: (702) 522-0701 |
| NPI Number | 1598389173 |
|---|---|
| Provider Enumeration Date | 05/30/2020 |
| Last Update Date | 06/05/2020 |
| Medicare PECOS PAC ID | 4981025541 |
|---|---|
| Medicare Enrollment ID | O20200608000166 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598389173 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Chima A Osuoha |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154445476 PECOS PAC ID: 7911052196 Enrollment ID: I20090911000636 |
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