MEDICARE: ATANS INC

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
1	207R00000X	Internal Medicine Physician
2	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1598389173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATANS INC

Provider Business Mailing Address
First Line	:	3328 HORNED LARK CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7712
Country	:	US
Telephone Number	:	205-249-8491
Fax Number	:	702-522-0701

Provider Business Practice Location Address
First Line	:	3599 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3344
Country	:	US
Telephone Number	:	702-522-0701
Fax Number	:	702-522-0701

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	CHIMA OSUOHA
Credential	:	MD
Telephone Number	:	205-249-8491

Provider Enumeration Date	:	05/30/2020
Last Update Date	:	06/05/2020

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