MEDICARE: SUNDANCE MEDICAL CENTER LLP

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1447301973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNDANCE MEDICAL CENTER LLP

Provider Business Mailing Address
First Line	:	105 N PECOS RD
Second Line	:	STE 113
City	:	HENDERSON
State	:	NV
Zip	:	89074-1995
Country	:	US
Telephone Number	:	702-263-4795
Fax Number	:	702-263-4804

Provider Business Practice Location Address
First Line	:	500 E WINDMILL LN STE 125
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1845
Country	:	US
Telephone Number	:	702-263-4795
Fax Number	:	702-263-4804

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	PATRICIA PECKHAM
Credential	:
Telephone Number	:	702-263-4795

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	12/06/2017

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