MEDICARE: SADY MEDICAL ENTERPRISES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	576	NV

General Provider Information

NPI Number	:	1184676728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SADY MEDICAL ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	4161 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5483
Country	:	US
Telephone Number	:	702-693-6222
Fax Number	:	702-369-6504

Provider Business Practice Location Address
First Line	:	4161 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5484
Country	:	US
Telephone Number	:	702-693-6222
Fax Number	:	702-369-6504

Authorized Official
Title or Position	:	PHYSICIAN'S ASSISTANT
Name	:	MR. BRIAN C SADY
Credential	:	PA-C
Telephone Number	:	702-693-6222

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	08/22/2020

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