Provider Demographics
NPI:1316973647
Name:INTERNAL MEDICINE ASSOCIATES OF SOUTHERN NEVADA, INC.
Entity type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF SOUTHERN NEVADA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TANVIR
Authorized Official - Middle Name:BIN
Authorized Official - Last Name:HOSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-649-8009
Mailing Address - Street 1:3196 S MARYLAND PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2313
Mailing Address - Country:US
Mailing Address - Phone:702-649-8009
Mailing Address - Fax:702-649-8049
Practice Address - Street 1:3196 S MARYLAND PKWY STE 202
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2313
Practice Address - Country:US
Practice Address - Phone:702-649-8009
Practice Address - Fax:702-649-8049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10688207RI0200X
NV10067207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVH57943Medicare UPIN
NVV102226Medicare ID - Type UnspecifiedMEDICARE GROUP