MEDICARE: PHYSICAL MEDICINE AND PAIN MANAGEMENT OF NEVADA, 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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician

General Provider Information

NPI Number	:	1952829764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL MEDICINE AND PAIN MANAGEMENT OF NEVADA, LLC

Provider Business Mailing Address
First Line	:	1930 VILLAGE CENTER CIR # 3-716
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6299
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2004 GLENVIEW DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134
Country	:	US
Telephone Number	:	702-408-1096
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FARZIN FARHANG
Credential	:	MD
Telephone Number	:	702-408-1096

Provider Enumeration Date	:	08/31/2017
Last Update Date	:	06/28/2018

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