MEDICARE: DIAGNOSTIC IMAGING OF SOUTHERN NEVADA

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	2085R0202X	Diagnostic Radiology Physician	2000048426	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063410918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAGNOSTIC IMAGING OF SOUTHERN NEVADA

Provider Business Mailing Address
First Line	:	3560 E FLAMINGO RD
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5044
Country	:	US
Telephone Number	:	702-433-6100
Fax Number	:	702-433-9576

Provider Business Practice Location Address
First Line	:	3560 E FLAMINGO RD
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5044
Country	:	US
Telephone Number	:	702-433-6100
Fax Number	:	702-433-9576

Authorized Official
Title or Position	:	MANAGER OF GENERAL PARTNER
Name	:	DR. MICHAEL ALLEN BARON
Credential	:	M.D.
Telephone Number	:	702-433-6100

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	10/16/2007

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Directions to “DIAGNOSTIC IMAGING OF SOUTHERN NEVADA ” Practice Location

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