Organization
JACOBS & MODABER MDS, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA A ESPOSITO (PRACTICE ADMINISTRATOR)
(702) 735-0258
Entity
Organization
Contact information
Practice address
2870 S MARYLAND PKWY, SUITE 300, LAS VEGAS, NV 89109-5031
(702) 735-0258
(702) 216-0216
Mailing address
2870 S MARYLAND PKWY, SUITE 300, LAS VEGAS, NV 89109-5031
(702) 735-0258
(702) 216-0216
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100502996
—
NV
01
—
26479
BCROSS-BSHIELD GRP#
NV
01
—
NV7045
FEDERAL BXBS GRP#
NV
Enumeration date
11/15/2006
Last updated
01/28/2010
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