MEDICARE: JSA PROFESSIONAL ASSOCIATION

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	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619906211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JSA PROFESSIONAL ASSOCIATION

Provider Business Mailing Address
First Line	:	700 E WARM SPRINGS RD
Second Line	:	SUITE 300
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-4305
Country	:	US
Telephone Number	:	702-932-8500
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 E WARM SPRINGS RD
Second Line	:	SUITE 300
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-4305
Country	:	US
Telephone Number	:	702-932-8547
Fax Number	:	702-932-8586

Authorized Official
Title or Position	:	PRESIDENT, SECRETARY AND TREASURER
Name	:	DR. BRUCE W FRIEMAN
Credential	:	DO
Telephone Number	:	727-824-0780

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	08/27/2008

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Directions to “JSA PROFESSIONAL ASSOCIATION ” Practice Location

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