Provider Demographics
NPI:1255452785
Name:GEORGE MED PEDS ASSOCIATES, P.C.
Entity type:Organization
Organization Name:GEORGE MED PEDS ASSOCIATES, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-253-5410
Mailing Address - Street 1:2725 S JONES BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5605
Mailing Address - Country:US
Mailing Address - Phone:702-253-5410
Mailing Address - Fax:702-433-5410
Practice Address - Street 1:6252 S RAINBOW BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3248
Practice Address - Country:US
Practice Address - Phone:702-253-5410
Practice Address - Fax:702-433-5410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11122208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506950Medicaid
NV100508862Medicaid
NV100508862Medicaid
NVV101112Medicare PIN