| Providence Medical Associates | |
|
1815 E Lake Mead Blvd Suite 204 N Las Vegas NV 89030-7187 | |
| (702) 798-1233 | |
| (702) 531-1233 |
| Full Name | Providence Medical Associates |
|---|---|
| Speciality | Pediatrics |
| Location | 1815 E Lake Mead Blvd, N Las Vegas, Nevada |
| Authorized Official Name and Position | Seth K. Adjovu (PRESIDENT/OWNER) |
| Authorized Official Contact | 7027981233 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Medical Associates 1815 E Lake Mead Blvd Suite 204 N Las Vegas NV 89030-7187 Ph: (702) 798-1233 | Providence Medical Associates 1815 E Lake Mead Blvd Suite 204 N Las Vegas NV 89030-7187 Ph: (702) 798-1233 |
| NPI Number | 1124029715 |
|---|---|
| Provider Enumeration Date | 08/03/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124029715 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 10335 (Nevada) | Primary |
| 208000000X | Pediatrics | 10335 (Nevada) | Primary |
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