Provider Demographics
NPI:1013929843
Name:GEORGES TANNOURY MD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:GEORGES TANNOURY MD PROFESSIONAL CORPORATION
Other - Org Name:SPECIALTY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGES
Authorized Official - Middle Name:Y
Authorized Official - Last Name:TANNOURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-751-3377
Mailing Address - Street 1:8550 W DESERT INN RD
Mailing Address - Street 2:STE 102-105
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-4401
Mailing Address - Country:US
Mailing Address - Phone:775-751-3377
Mailing Address - Fax:775-751-2323
Practice Address - Street 1:1280 E CALVADA BLVD
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-5693
Practice Address - Country:US
Practice Address - Phone:775-751-3377
Practice Address - Fax:775-751-2323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506247Medicaid
NV100506247Medicaid