Provider Demographics
NPI:1023318177
Name:MEDICAL ASSOCIATES OF SOUTHERN NEVADA
Entity type:Organization
Organization Name:MEDICAL ASSOCIATES OF SOUTHERN NEVADA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GOVIND
Authorized Official - Middle Name:VENKATA
Authorized Official - Last Name:KOKA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-492-7208
Mailing Address - Street 1:PO BOX 778195
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89077-8195
Mailing Address - Country:US
Mailing Address - Phone:702-492-7208
Mailing Address - Fax:702-407-5645
Practice Address - Street 1:9975 S EASTERN AVE
Practice Address - Street 2:110A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-7949
Practice Address - Country:US
Practice Address - Phone:702-492-7208
Practice Address - Fax:702-407-5645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1001208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV1001OtherDO LICENSE NV1001
NVH51767Medicare UPIN