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NPI Code Detail

MEDICARE: GOLDSMITH HEALTHCARE, LTD

MEDICARE: GOLDSMITH HEALTHCARE, LTD
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
1207Q00000XFamily Medicine Physician6116NV
2363A00000XPhysician AssistantPA1149NV
3207R00000XInternal Medicine Physician6116NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
16116OTHERNVNV MEDICAL LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881651826
Entity Type Code : Organization
Provider Name (Legal Business Name) : GOLDSMITH HEALTHCARE, LTD
Provider Business Mailing Address
First Line : 5375 S FORT APACHE RD
Second Line : #102-103
City : LAS VEGAS
State : NV
Zip : 89148-7623
Country : US
Telephone Number : 702-646-9444
Fax Number : 702-646-9022
Provider Business Practice Location Address
First Line : 5375 S FORT APACHE RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-7623
Country : US
Telephone Number : 702-367-0808
Fax Number : 702-367-1339
Authorized Official
Title or Position : OWNER/DIRECTOR
Name : DR. IVAN LEE GOLDSMITH
Credential : M.D.
Telephone Number : 702-367-0808
Provider Enumeration Date : 04/26/2006
Last Update Date : 08/06/2014

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Directions to “GOLDSMITH HEALTHCARE, LTD ” Practice Location

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