MEDICARE: ULTIMATE 'U' MEDICAL , INC

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1154719615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTIMATE 'U' MEDICAL , INC

Provider Business Mailing Address
First Line	:	2651 N GREEN VALLEY PKWY STE 103
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-0234
Country	:	US
Telephone Number	:	702-353-9777
Fax Number	:	702-776-7464

Provider Business Practice Location Address
First Line	:	2651 N GREEN VALLEY PKWY
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-0266
Country	:	US
Telephone Number	:	702-353-9777
Fax Number	:	702-776-7464

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KATHLEEN D SMITH
Credential	:	M.D.
Telephone Number	:	702-353-9777

Provider Enumeration Date	:	01/06/2015
Last Update Date	:	09/11/2020

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