MEDICARE: PROFESSIONAL AUTHORIZATION CLAIM SERVICE

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	246Y00000X	Health Information Specialist/Technologist	010H2011300605	NV

General Provider Information

NPI Number	:	1528357373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL AUTHORIZATION CLAIM SERVICE

Provider Business Mailing Address
First Line	:	1818 MOSER DR.
Second Line	:	#B
City	:	HENDERSON
State	:	NV
Zip	:	89011-4478
Country	:	US
Telephone Number	:	702-998-5206
Fax Number	:	702-998-5206

Provider Business Practice Location Address
First Line	:	1818 MOSER DR.
Second Line	:	#B
City	:	HENDERSON
State	:	NV
Zip	:	89011-4478
Country	:	US
Telephone Number	:	702-998-5206
Fax Number	:	702-998-5206

Authorized Official
Title or Position	:	OWNER/CBCS
Name	:	MS. CARMEN ZORAIDA COLON
Credential	:	CBCS
Telephone Number	:	702-998-2506

Provider Enumeration Date	:	04/01/2011
Last Update Date	:	04/01/2011

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