Healthcare Provider Details

I. General information

NPI: 1619906211
Provider Name (Legal Business Name): JSA PROFESSIONAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E WARM SPRINGS RD SUITE 300
LAS VEGAS NV
89119-4305
US

IV. Provider business mailing address

700 E WARM SPRINGS RD SUITE 300
LAS VEGAS NV
89119-4305
US

V. Phone/Fax

Practice location:
  • Phone: 702-932-8547
  • Fax: 702-932-8586
Mailing address:
  • Phone: 702-932-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRUCE W FRIEMAN
Title or Position: PRESIDENT, SECRETARY AND TREASURER
Credential: DO
Phone: 727-824-0780