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NPI Code Detail

MEDICARE: NATHAN IBE OZOBIA MD CHARTERED

MEDICARE: NATHAN IBE OZOBIA MD CHARTERED
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1282N00000XGeneral Acute Care Hospital3239NV
2174400000XSpecialist3239NV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CS969AOTHERNVMEDICARE PTAN

General Provider Information

NPI Number : 1538491964
Entity Type Code : Organization
Provider Name (Legal Business Name) : NATHAN IBE OZOBIA MD CHARTERED
Provider Business Mailing Address
First Line : PO BOX 27619
Second Line :
City : LAS VEGAS
State : NV
Zip : 89126-1619
Country : US
Telephone Number : 702-643-0500
Fax Number : 702-471-1049
Provider Business Practice Location Address
First Line : 5701 W CHARLESTON BLVD
Second Line : SUITE 105
City : LAS VEGAS
State : NV
Zip : 89146-1217
Country : US
Telephone Number : 702-643-0500
Fax Number : 702-471-1049
Authorized Official
Title or Position : PRESIDENT
Name : DR. NATHAN IBEZIMAKO OZOBIA
Credential : MD FACS
Telephone Number : 702-643-0500
Provider Enumeration Date : 02/10/2010
Last Update Date : 09/25/2014

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