MEDICARE: MEDICATION ASSISTED TREATMENT LAS VEGAS

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	276400000X	Substance Use Disorder Rehabilitation Hospital Unit

General Provider Information

NPI Number	:	1134629116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICATION ASSISTED TREATMENT LAS VEGAS

Provider Business Mailing Address
First Line	:	7315 W WARM SPRINGS RD STE 140
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-3615
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7315 W WARM SPRINGS RD STE 140
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-3615
Country	:	US
Telephone Number	:	800-655-4790
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MORGAN ROUW
Credential	:
Telephone Number	:	702-373-9345

Provider Enumeration Date	:	02/16/2018
Last Update Date	:	02/16/2018

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