MEDICARE: SOUTHERN NEVADA PHYSICIANS LLP

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	207R00000X	Internal Medicine Physician		NV

General Provider Information

NPI Number	:	1992816896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN NEVADA PHYSICIANS LLP

Provider Business Mailing Address
First Line	:	3535 LAS VEGAS BLVD S
Second Line	:	8TH FLOOR
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-8921
Country	:	US
Telephone Number	:	702-309-5144
Fax Number	:	702-309-5344

Provider Business Practice Location Address
First Line	:	3535 LAS VEGAS BLVD S
Second Line	:	8TH FLOOR
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-8921
Country	:	US
Telephone Number	:	702-309-5144
Fax Number	:	702-309-5344

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH BOATENG III
Credential	:	M.D.
Telephone Number	:	702-309-5144

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/22/2020

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