MEDICARE: TOURO UNIVERSITY

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	10815	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	:	1265731152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOURO UNIVERSITY

Provider Business Mailing Address
First Line	:	PO BOX 531730
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89053-1730
Country	:	US
Telephone Number	:	702-777-3138
Fax Number	:	702-777-2069

Provider Business Practice Location Address
First Line	:	WILLOW CREEK AL -SAN MARTIN, 8374 W. CAPOVILLA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-3305
Country	:	US
Telephone Number	:	702-222-3600
Fax Number	:	702-777-4822

Authorized Official
Title or Position	:	VICE PRESIDENT FOR ADMINISTRATION
Name	:	CRAIG M SEIDEN
Credential	:	CPA
Telephone Number	:	702-777-4794

Provider Enumeration Date	:	03/18/2011
Last Update Date	:	03/18/2011

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Directions to “TOURO UNIVERSITY ” Practice Location

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