MEDICARE: NORTH VISTA HOSPITAL DBA TOTAL CARE MANAGEMENT ASSOCIATES

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	261Q00000X	Clinic/Center	649HOS-22	NV

General Provider Information

NPI Number	:	1396922761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH VISTA HOSPITAL DBA TOTAL CARE MANAGEMENT ASSOCIATES

Provider Business Mailing Address
First Line	:	10777 W TWAIN AVE
Second Line	:	SUITE 225
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-3034
Country	:	US
Telephone Number	:	702-839-0946
Fax Number	:	702-839-0149

Provider Business Practice Location Address
First Line	:	2365 REYNOLDS AVE
Second Line	:	SUITE 111
City	:	N LAS VEGAS
State	:	NV
Zip	:	89030-7267
Country	:	US
Telephone Number	:	702-399-1287
Fax Number	:	702-399-6537

Authorized Official
Title or Position	:	CEO
Name	:	TONY MARINELLO
Credential	:
Telephone Number	:	702-657-5504

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	01/28/2008

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