Provider Demographics
NPI:1417694019
Name:PHYSICIAN ASSOCIATES OF NEVADA LTD
Entity Type:Organization
Organization Name:PHYSICIAN ASSOCIATES OF NEVADA LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:RADIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:702-307-5522
Mailing Address - Street 1:2900 W HORIZON RIDGE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5014
Mailing Address - Country:US
Mailing Address - Phone:702-307-5522
Mailing Address - Fax:702-991-7258
Practice Address - Street 1:2900 W HORIZON RIDGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5014
Practice Address - Country:US
Practice Address - Phone:702-307-5522
Practice Address - Fax:702-991-7258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty