Provider Demographics
NPI:1619906211
Name:JSA PROFESSIONAL ASSOCIATION
Entity type:Organization
Organization Name:JSA PROFESSIONAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, SECRETARY AND TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:FRIEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-824-0780
Mailing Address - Street 1:700 E WARM SPRINGS RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-4305
Mailing Address - Country:US
Mailing Address - Phone:702-932-8500
Mailing Address - Fax:
Practice Address - Street 1:700 E WARM SPRINGS RD
Practice Address - Street 2:SUITE 300
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-4305
Practice Address - Country:US
Practice Address - Phone:702-932-8547
Practice Address - Fax:702-932-8586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100509715Medicaid
NV100509715Medicaid
NV102496Medicare PIN