Provider Demographics
NPI:1114114865
Name:FAMILY FIRST MEDICAL LLC
Entity Type:Organization
Organization Name:FAMILY FIRST MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVARISTA
Authorized Official - Middle Name:CHRISTIANA
Authorized Official - Last Name:NNADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-260-0577
Mailing Address - Street 1:1725 E WARM SPRINGS RD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-0420
Mailing Address - Country:US
Mailing Address - Phone:702-260-0577
Mailing Address - Fax:
Practice Address - Street 1:1725 E WARM SPRINGS RD
Practice Address - Street 2:SUITE 12
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-0420
Practice Address - Country:US
Practice Address - Phone:702-260-0577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10975207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV100618Medicare PIN
NVF33380Medicare UPIN