MEDICARE: PATIENT PAL URGENT CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center	2000179062190	NV

General Provider Information

NPI Number	:	1013332378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATIENT PAL URGENT CARE LLC

Provider Business Mailing Address
First Line	:	11860 SOUTHERN HIGHLANDS PKWY
Second Line	:	#102
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-3303
Country	:	US
Telephone Number	:	702-737-2273
Fax Number	:	702-823-2556

Provider Business Practice Location Address
First Line	:	11860 SOUTHERN HIGHLANDS PKWY
Second Line	:	#102
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-3303
Country	:	US
Telephone Number	:	702-737-2273
Fax Number	:	702-823-2556

Authorized Official
Title or Position	:	RN, CPCS
Name	:	MRS. ROSA PADILLA
Credential	:
Telephone Number	:	702-737-2273

Provider Enumeration Date	:	02/24/2014
Last Update Date	:	02/24/2014

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