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General NPI Number Information
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NPI Number | 1083239925
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Entity Type | Organization
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Legal Business Name | PHYSICIANS OF AMERICA
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Dates
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Enumeration Date | 06/16/2020
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Last Update Date | 03/17/2022
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Provider Practice Location Address
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Address Line | 10785 W TWAIN AVE STE 219
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City | LAS VEGAS
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State | NV
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Zip | 89135-3028
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Country | US
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Telephone | 702-246-2620
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Fax |
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Provider Business Mailing Address
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Address Line | 3375 S RAINBOW BLVD # 81857
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City | LAS VEGAS
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State | NV
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Zip | 89146-9995
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | TIMOTHY JEIDER
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Credential | MD
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Telephone | 702-246-2620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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