Healthcare Provider Details

I. General information

NPI: 1174167746
Provider Name (Legal Business Name): MOYER MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8515 EDNA AVE STE 160
LAS VEGAS NV
89117-4429
US

IV. Provider business mailing address

11459 OPAL SPRINGS WAY
LAS VEGAS NV
89135-3421
US

V. Phone/Fax

Practice location:
  • Phone: 702-330-3490
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA AMADEUS MOYER
Title or Position: AUTHORIZED OFFICIAL
Credential: APRN
Phone: 702-330-3490