MEDICARE: LAS VEGAS URGENT CARE

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	146N00000X	Basic Emergency Medical Technician	CNP00739	NM

General Provider Information

NPI Number	:	1871876607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS VEGAS URGENT CARE

Provider Business Mailing Address
First Line	:	600 MILLS AVE STE B
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4669
Country	:	US
Telephone Number	:	505-425-2673
Fax Number	:	505-425-3086

Provider Business Practice Location Address
First Line	:	600 MILLS AVE STE B
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4669
Country	:	US
Telephone Number	:	505-425-2673
Fax Number	:	505-425-3086

Authorized Official
Title or Position	:	CREDENTIALING CORRDINATOR
Name	:	LISA M GURULE
Credential	:
Telephone Number	:	505-474-6097

Provider Enumeration Date	:	09/28/2011
Last Update Date	:	09/28/2011

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