MEDICARE: GREEN VALLEY ANESTHESIA SERVICES

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	261QA1903X	Ambulatory Surgical Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V101876	OTHER	NV	MEDICARE GROUP

General Provider Information

NPI Number	:	1710179940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN VALLEY ANESTHESIA SERVICES

Provider Business Mailing Address
First Line	:	8845 ZURICH CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-8100
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3560 E FLAMINGO RD
Second Line	:	SUITE 105
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5044
Country	:	US
Telephone Number	:	702-454-8712
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	MR. GEORGE H COX
Credential	:	CRNA
Telephone Number	:	702-227-3072

Provider Enumeration Date	:	08/12/2007
Last Update Date	:	01/03/2008

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Directions to “GREEN VALLEY ANESTHESIA SERVICES ” Practice Location

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