Provider Demographics
NPI:1750454302
Name:JACOBS & MODABER MDS, LTD.
Entity Type:Organization
Organization Name:JACOBS & MODABER MDS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESPOSITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-735-0258
Mailing Address - Street 1:2870 S MARYLAND PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-5031
Mailing Address - Country:US
Mailing Address - Phone:702-735-0258
Mailing Address - Fax:702-216-0216
Practice Address - Street 1:2870 S MARYLAND PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-5031
Practice Address - Country:US
Practice Address - Phone:702-735-0258
Practice Address - Fax:702-216-0216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502996Medicaid
NV26479OtherBCROSS-BSHIELD GRP#
NVNV7045OtherFEDERAL BXBS GRP#
NV26479OtherBCROSS-BSHIELD GRP#