Provider Demographics
NPI:1043393309
Name:NEVADA MEDICAL SYSTEMS, INC.
Entity Type:Organization
Organization Name:NEVADA MEDICAL SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-399-1600
Mailing Address - Street 1:PO BOX 897
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83701
Mailing Address - Country:US
Mailing Address - Phone:702-399-1600
Mailing Address - Fax:702-399-5375
Practice Address - Street 1:2516 E LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-6414
Practice Address - Country:US
Practice Address - Phone:702-399-1600
Practice Address - Fax:702-399-5375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1938NTC-10261QM2800X
NV261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502427Medicaid