Provider Demographics
NPI:1760048326
Name:THE PHYSICIANS MA LLC
Entity Type:Organization
Organization Name:THE PHYSICIANS MA LLC
Other - Org Name:SOROMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMERIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUMBS
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:702-444-8019
Mailing Address - Street 1:2121 E FLAMINGO RD STE 214
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5124
Mailing Address - Country:US
Mailing Address - Phone:702-444-8019
Mailing Address - Fax:702-570-2694
Practice Address - Street 1:2121 E FLAMINGO RD STE 214
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5124
Practice Address - Country:US
Practice Address - Phone:708-444-8019
Practice Address - Fax:702-570-2694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-18
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service