MEDICARE: ALPHA MEDICAL CENTRE WALTERS, LTD

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	261QP2300X	Primary Care Clinic/Center	4017	NV

General Provider Information

NPI Number	:	1902268501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA MEDICAL CENTRE WALTERS, LTD

Provider Business Mailing Address
First Line	:	348 N NELLIS BLVD
Second Line	:	SUITE E
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-0053
Country	:	US
Telephone Number	:	702-570-5072
Fax Number	:	702-570-5384

Provider Business Practice Location Address
First Line	:	348 N NELLIS BLVD
Second Line	:	SUITE E
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-0053
Country	:	US
Telephone Number	:	702-570-5072
Fax Number	:	702-570-5384

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	ROSA GONZALEZ
Credential	:
Telephone Number	:	702-540-3499

Provider Enumeration Date	:	03/23/2016
Last Update Date	:	06/17/2016

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