MEDICARE: SOUTHWEST LAS VEGAS SLEEP CENTER

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	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

General Provider Information

NPI Number	:	1538117361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST LAS VEGAS SLEEP CENTER

Provider Business Mailing Address
First Line	:	4830 W LONE MOUNTAIN RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-2239
Country	:	US
Telephone Number	:	702-732-3200
Fax Number	:	702-549-3301

Provider Business Practice Location Address
First Line	:	4830 W LONE MOUNTAIN RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-2239
Country	:	US
Telephone Number	:	702-732-3200
Fax Number	:	702-549-3301

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANTHONY F DI MARCO
Credential	:	MD
Telephone Number	:	702-732-3200

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	08/22/2020

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