MEDICARE: DR EARL JACOBSON LTD FOOT CARE CLINIC

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	261QP1100X	Podiatric Clinic/Center	43	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NV5554	OTHER	NV	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	756480688	OTHER	NV	PALMETTO GBA RAILROAD

General Provider Information

NPI Number	:	1366674194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR EARL JACOBSON LTD FOOT CARE CLINIC

Provider Business Mailing Address
First Line	:	3650 S. EASTERN AVE
Second Line	:	SUITE 200
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3345
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3650 S. EASTERN AVE
Second Line	:	SUITE 200
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3345
Country	:	US
Telephone Number	:	702-384-2544
Fax Number	:	702-384-8528

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EARL JACOBSON
Credential	:
Telephone Number	:	702-384-2544

Provider Enumeration Date	:	08/12/2009
Last Update Date	:	04/01/2024

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