MEDICARE: FIDELIS HEALTH GROUP 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PH03042	NV
3	3336S0011X	Specialty Pharmacy

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	:	1255761128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIDELIS HEALTH GROUP LLC

Provider Business Mailing Address
First Line	:	5275 ARVILLE ST STE 156
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-4937
Country	:	US
Telephone Number	:	702-815-0800
Fax Number	:	702-815-0801

Provider Business Practice Location Address
First Line	:	5275 ARVILLE ST STE 156
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-4937
Country	:	US
Telephone Number	:	702-815-0800
Fax Number	:	702-815-0801

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WAGNER A LEMUS
Credential	:
Telephone Number	:	702-815-0800

Provider Enumeration Date	:	11/13/2013
Last Update Date	:	09/20/2018

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Directions to “FIDELIS HEALTH GROUP LLC ” Practice Location

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