MEDICARE: ANTHONY M RICCIARDI JR LTD INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies	9507	NV

General Provider Information

NPI Number	:	1871746453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTHONY M RICCIARDI JR LTD INC.

Provider Business Mailing Address
First Line	:	7135 W SAHARA AVE
Second Line	:	SUITE 201
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2873
Country	:	US
Telephone Number	:	702-878-2455
Fax Number	:	702-878-4875

Provider Business Practice Location Address
First Line	:	3175 SAINT ROSE PKWY
Second Line	:	SUITE 320
City	:	HENDERSON
State	:	NV
Zip	:	89052-3506
Country	:	US
Telephone Number	:	702-878-2455
Fax Number	:	702-878-4875

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANTHONY M RICCIARDI JR.
Credential	:	DPM
Telephone Number	:	702-878-2455

Provider Enumeration Date	:	10/28/2008
Last Update Date	:	02/21/2017

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