MEDICARE: P. JAMES SOMERS, MS, PA-C, 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
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center	PA658	NV
2	261QM0850X	Adult Mental Health Clinic/Center	PA658	NV

General Provider Information

NPI Number	:	1942445556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	P. JAMES SOMERS, MS, PA-C, LTD

Provider Business Mailing Address
First Line	:	3315 E RUSSELL RD
Second Line	:	SUITE A-4 #410
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3459
Country	:	US
Telephone Number	:	702-349-8399
Fax Number	:	702-537-5736

Provider Business Practice Location Address
First Line	:	2780 S JONES BLVD
Second Line	:	SUITE 205
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5628
Country	:	US
Telephone Number	:	702-217-8030
Fax Number	:	702-537-5736

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JAMES CLARK SOMERS
Credential	:	MS, PA-C
Telephone Number	:	702-349-8399

Provider Enumeration Date	:	12/10/2008
Last Update Date	:	08/12/2014

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