Provider Demographics
NPI:1144090770
Name:LAS VEGAS MOBILE MEDICAL GROUP PC
Entity type:Organization
Organization Name:LAS VEGAS MOBILE MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SHYLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:TIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-347-8548
Mailing Address - Street 1:9017 S PECOS RD STE 4540
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-6604
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9017 S PECOS RD STE 4540
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-6604
Practice Address - Country:US
Practice Address - Phone:626-347-8548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty