MEDICARE: NEW IMAGE MEDICAL NETWORK, L.L.C.

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	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1760762066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW IMAGE MEDICAL NETWORK, L.L.C.

Provider Business Mailing Address
First Line	:	3481 E SUNSET RD
Second Line	:	SUITE 100-I
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3228
Country	:	US
Telephone Number	:	702-750-2770
Fax Number	:	702-750-2771

Provider Business Practice Location Address
First Line	:	3481 E SUNSET RD
Second Line	:	SUITE 100-I
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3228
Country	:	US
Telephone Number	:	702-750-2770
Fax Number	:	702-750-2771

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL L BRADLEY JR.
Credential	:
Telephone Number	:	310-435-0644

Provider Enumeration Date	:	08/18/2011
Last Update Date	:	08/18/2011

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