MEDICARE: ORTHOPEDICS & SPORTS MEDICINE LLC

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	225100000X	Physical Therapist
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician

General Provider Information

NPI Number	:	1265419014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPEDICS & SPORTS MEDICINE LLC

Provider Business Mailing Address
First Line	:	PO BOX 97618
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89193-7618
Country	:	US
Telephone Number	:	702-933-9393
Fax Number	:	702-933-6789

Provider Business Practice Location Address
First Line	:	9499 W CHARLESTON BLVD
Second Line	:	STE 200
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7147
Country	:	US
Telephone Number	:	702-933-9393
Fax Number	:	702-933-6789

Authorized Official
Title or Position	:	BUSINESS OFFICE MANAGER
Name	:	CARMELINA SIMON
Credential	:
Telephone Number	:	702-933-9393

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	12/02/2025

Similar Medicare Providers

1932785474 — JOSHUA DARRYL HARDY MD
Practice Location Address:

9499 W CHARLESTON BLVD STE 200
LAS VEGAS, NV
89117-7147

Practice Phone: 702-445-2150
Practice Fax:

1902807613 — STEVEN C THOMAS MD
Practice Location Address:

9499 W CHARLESTON BLVD , STE 200
LAS VEGAS, NV
89117-7147

Practice Phone: 702-933-9393
Practice Fax: 702-933-6789

1437151917 — ROBERT CLINTON HAYES MD
Practice Location Address:

9499 W CHARLESTON BLVD STE 150
LAS VEGAS, NV
89117-7147

Practice Phone: 775-727-5509
Practice Fax: 775-727-5696

1770551426 — RUSSELL KEVIN BOULDIN R.P.T
Practice Location Address:

9499 W CHARLESTON BLVD , SUITE 220
LAS VEGAS, NV
89117-7147

Practice Phone: 702-933-9394
Practice Fax: 702-933-9395

1720038185 — SUNEETHA CHINTA M.D.
Practice Location Address:

9499 W CHARLESTON BLVD STE 150
LAS VEGAS, NV
89117-7147

Practice Phone: 702-228-5477
Practice Fax: 702-255-7981

1538112792 — DR. DONALD W. PENNINGTON D.O.
Practice Location Address:

9499 W CHARLESTON BLVD STE 200
LAS VEGAS, NV
89117-7147

Practice Phone: 29-339-3937
Practice Fax: 702-933-6789

Directions to “ORTHOPEDICS & SPORTS MEDICINE LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.