Organization
EDICINE IM PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL PAUL CARSON (BIILLING MANAGER)
(480) 626-1415
Entity
Organization
Contact information
Practice address
2828 E LAKE MEAD BLVD, NORTH LAS VEGAS, NV 89030-6548
(480) 488-8020
Mailing address
34597 N 60RH STREET, SUITE 110, SCOTTSDALE, AZ 85266-5240
(480) 488-8020
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
06/12/2023
Last updated
06/12/2023
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