MEDICARE: VETERANS ADMINISTRATION

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	282N00000X	General Acute Care Hospital	2359C	NV

General Provider Information

NPI Number	:	1558453571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VETERANS ADMINISTRATION

Provider Business Mailing Address
First Line	:	5516 VANSVILLE WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3601
Country	:	US
Telephone Number	:	702-642-4762
Fax Number	:

Provider Business Practice Location Address
First Line	:	5516 VANSVILLE WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3601
Country	:	US
Telephone Number	:	702-642-4762
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER
Name	:	MRS. MARILYN ELAINE JUAREZ
Credential	:
Telephone Number	:	702-653-3232

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	08/22/2020

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