Provider Demographics
NPI:1679631220
Name:J SHERMAN TATE MD LTD
Entity Type:Organization
Organization Name:J SHERMAN TATE MD LTD
Other - Org Name:IMANI HEALTH CARE ASSOCIATES PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:SHERMAN
Authorized Official - Last Name:TATE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:702-388-4292
Mailing Address - Street 1:PO BOX 270700
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89127-4700
Mailing Address - Country:US
Mailing Address - Phone:702-388-4292
Mailing Address - Fax:702-388-2922
Practice Address - Street 1:501 SOUTH RANCHO DRIVE
Practice Address - Street 2:SUITE E-32
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4833
Practice Address - Country:US
Practice Address - Phone:701-388-4292
Practice Address - Fax:702-388-2922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100501136Medicaid
NV34413Medicare ID - Type Unspecified