Innovative Care Physicians | |
5375 S Fort Apache Rd Las Vegas NV 89148-7623 | |
(702) 367-0808 | |
(702) 367-1339 |
Full Name | Innovative Care Physicians |
---|---|
Speciality | Internal Medicine |
Location | 5375 S Fort Apache Rd, Las Vegas, Nevada |
Authorized Official Name and Position | Ivan Lee Goldsmith (OWNER/DIRECTOR) |
Authorized Official Contact | 7023670808 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Innovative Care Physicians 5375 S Fort Apache Rd #102-103 Las Vegas NV 89148-7623 Ph: (702) 646-9444 | Innovative Care Physicians 5375 S Fort Apache Rd Las Vegas NV 89148-7623 Ph: (702) 367-0808 |
NPI Number | 1881651826 |
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Provider Enumeration Date | 04/26/2006 |
Last Update Date | 08/06/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1881651826 | NPI | - | NPPES |
6116 | Other | NV | NV MEDICAL LICENSE |
2019160 | Medicaid | NV |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 6116 (Nevada) | Secondary |
207R00000X | Internal Medicine | 6116 (Nevada) | Primary |
363A00000X | Physician Assistant | PA1149 (Nevada) | Secondary |
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