Organization
GOOD SAM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN LACY APRN (CEO)
(210) 724-8656
Entity
Organization
Contact information
Practice address
3651 LINDELL RD, LAS VEGAS, NV 89103-1254
(702) 909-6400
Mailing address
8905 EVENING STAR DR, LAS VEGAS, NV 89134-8806
(702) 909-6400
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
04/23/2021
Last updated
04/23/2021
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