MEDICARE: OSTEOPATHIC MEDICAL ASSOCIATES OF NEVADA

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	207QA0505X	Adult Medicine Physician

General Provider Information

NPI Number	:	1841377157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OSTEOPATHIC MEDICAL ASSOCIATES OF NEVADA

Provider Business Mailing Address
First Line	:	5410 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-3307
Country	:	US
Telephone Number	:	702-362-2500
Fax Number	:	702-876-6581

Provider Business Practice Location Address
First Line	:	5410 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-3307
Country	:	US
Telephone Number	:	702-362-2500
Fax Number	:	702-876-6581

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	MRS. LEAH TWIST
Credential	:
Telephone Number	:	702-362-2500

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/22/2020

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