Provider Demographics
NPI:1538491964
Name:NATHAN IBE OZOBIA MD CHARTERED
Entity Type:Organization
Organization Name:NATHAN IBE OZOBIA MD CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:IBEZIMAKO
Authorized Official - Last Name:OZOBIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACS
Authorized Official - Phone:702-643-0500
Mailing Address - Street 1:PO BOX 27619
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89126-1619
Mailing Address - Country:US
Mailing Address - Phone:702-643-0500
Mailing Address - Fax:702-471-1049
Practice Address - Street 1:5701 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1217
Practice Address - Country:US
Practice Address - Phone:702-643-0500
Practice Address - Fax:702-471-1049
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATHAN IBE OZOBIA MD FICS CHARTERED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-10
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3239174400000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCS969AOtherMEDICARE PTAN
NVA36096Medicare UPIN