Provider Demographics
NPI:1023443561
Name:UNSOM MULTISPECIALITY GROUP PRACTICE SOUTH, INC
Entity type:Organization
Organization Name:UNSOM MULTISPECIALITY GROUP PRACTICE SOUTH, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZAMBONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-671-2222
Mailing Address - Street 1:1701 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2325
Mailing Address - Country:US
Mailing Address - Phone:702-671-2395
Mailing Address - Fax:702-382-5388
Practice Address - Street 1:2040 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 202A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2227
Practice Address - Country:US
Practice Address - Phone:702-671-6475
Practice Address - Fax:702-671-6440
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNSOM MULTISPECIALTY GROUP PRACTICE SOUTH, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVVWQBHVMedicare UPIN