Provider Demographics
NPI:1508246752
Name:GOLDSMITH HEALTHCARE, LTD
Entity Type:Organization
Organization Name:GOLDSMITH HEALTHCARE, LTD
Other - Org Name:INNOVATIVE CARE PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GOLDSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-646-9444
Mailing Address - Street 1:5375 S FORT APACHE RD
Mailing Address - Street 2:102-103
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-7623
Mailing Address - Country:US
Mailing Address - Phone:702-646-9444
Mailing Address - Fax:702-646-9022
Practice Address - Street 1:5375 S FORT APACHE RD
Practice Address - Street 2:102-103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-7623
Practice Address - Country:US
Practice Address - Phone:702-646-9444
Practice Address - Fax:702-646-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6116101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV6116OtherNV MEDICAL LICENSE
NV2019160Medicaid