MEDICARE: AGATA-VENGER PARTNERSHIP

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	207T00000X	Neurological Surgery Physician		NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CI5556	OTHER	NV	RAILROAD MEDICARE
2	DE5316	OTHER	UT	RAILROAD MEDICARE
3	DB1501	OTHER	AZ	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	VWJBHW	OTHER	NV	PALMETTO J1

General Provider Information

NPI Number	:	1093772204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGATA-VENGER PARTNERSHIP

Provider Business Mailing Address
First Line	:	3061 S. MARYLAND PARKWAY
Second Line	:	SUITE #200
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-6227
Country	:	US
Telephone Number	:	702-737-1948
Fax Number	:	702-735-0742

Provider Business Practice Location Address
First Line	:	3061 S. MARYLAND PARKWAY
Second Line	:	SUITE #200
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-6227
Country	:	US
Telephone Number	:	702-737-1948
Fax Number	:	702-735-0742

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	DEBRA HARPER
Credential	:
Telephone Number	:	702-737-1948

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	07/23/2012

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Directions to “AGATA-VENGER PARTNERSHIP ” Practice Location

Language	Start Address	Practice Location

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