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General NPI Number Information
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NPI Number | 1134660137
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Entity Type | Organization
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Legal Business Name | NEW IMAGE MEDICAL INC.
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Dates
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Enumeration Date | 03/10/2017
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 2610 S JONES BLVD STE B
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City | LAS VEGAS
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State | NV
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Zip | 89146-5663
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Country | US
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Telephone | 877-302-8630
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Fax |
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Provider Business Mailing Address
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Address Line | 4474 SAGE BRUSH ST
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City | LAS VEGAS
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State | NV
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Zip | 89121-5711
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Country | US
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Telephone | 877-302-8630
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Fax | 877-302-8630
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL LYNN BRADLEY
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Credential |
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Telephone | 877-302-8630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 8638
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License Number State | NV
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