Healthcare Provider Details

I. General information

NPI: 1932349263
Provider Name (Legal Business Name): OVERTON MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 N MOAPA VALLEY BLVD
OVERTON NV
89040
US

IV. Provider business mailing address

PO BOX 517
OVERTON NV
89040-0517
US

V. Phone/Fax

Practice location:
  • Phone: 702-397-6344
  • Fax: 702-397-6342
Mailing address:
  • Phone: 702-397-6344
  • Fax: 702-397-6342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VICTOR K LEAVITT
Title or Position: PRESIDENT
Credential:
Phone: 702-397-6344