Provider Demographics
NPI:1457630568
Name:SIMON FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:SIMON FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:678-939-9665
Mailing Address - Street 1:1995 ERRECART BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-8346
Mailing Address - Country:US
Mailing Address - Phone:866-403-8476
Mailing Address - Fax:866-374-7518
Practice Address - Street 1:1995 ERRECART BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-8346
Practice Address - Country:US
Practice Address - Phone:866-403-8476
Practice Address - Fax:866-374-7518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-06
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVFI107AMedicare PIN