Good Sam LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

GOOD SAM LLC

Practice address

3651 Lindell Rd
Las Vegas, NV 89103-1254

Phone

(702) 909-6400

NPI assigned

Apr 23, 2021

Last updated

Apr 23, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John Lacy, APRN

Title

Ceo

Phone

(210) 724-8656

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1619136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619136000000",
    "number": "1922680453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8905 EVENING STAR DR",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891348806",
            "telephone_number": "702-909-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3651 LINDELL RD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891031254",
            "telephone_number": "702-909-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-23",
        "last_updated": "2021-04-23",
        "certification_date": "2021-04-23",
        "status": "A",
        "authorized_official_last_name": "LACY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "210-724-8656",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Internal Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.