MEDICARE: AXIOM IMAGING OF LAS VEGAS 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	2085R0204X	Vascular & Interventional Radiology Physician
2	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

General Provider Information

NPI Number	:	1346312642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AXIOM IMAGING OF LAS VEGAS LLC

Provider Business Mailing Address
First Line	:	6460 MEDICAL CENTER ST
Second Line	:	STE. 150
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-2406
Country	:	US
Telephone Number	:	702-868-2781
Fax Number	:	702-868-2782

Provider Business Practice Location Address
First Line	:	6460 MEDICAL CENTER ST
Second Line	:	STE. 150
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-2406
Country	:	US
Telephone Number	:	702-868-2781
Fax Number	:	702-868-2782

Authorized Official
Title or Position	:	FACILITY MANAGER
Name	:	MR. MARK SORIANO
Credential	:	R.T.
Telephone Number	:	702-868-2781

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	12/03/2007

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