Provider Demographics
NPI:1598114860
Name:MEDICAL SYSTEMS MANAGEMENT
Entity Type:Organization
Organization Name:MEDICAL SYSTEMS MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEJMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BADY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:775-513-4611
Mailing Address - Street 1:PO BOX 6255
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89041-6255
Mailing Address - Country:US
Mailing Address - Phone:775-513-4611
Mailing Address - Fax:
Practice Address - Street 1:9280 W SUNSET RD
Practice Address - Street 2:SUITE 412
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4860
Practice Address - Country:US
Practice Address - Phone:775-513-4611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV828204C00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1134146111Medicaid
NVP00870033OtherRAILROAD MEDICARE
NVP00870033OtherRAILROAD MEDICARE