MEDICARE: BOWER TAKE CARE HEALTH NEVADA, PC

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	363A00000X	Physician Assistant
2	363LF0000X	Family Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912103706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOWER TAKE CARE HEALTH NEVADA, PC

Provider Business Mailing Address
First Line	:	1901 E VOORHEES ST
Second Line	:	MS 640
City	:	DANVILLE
State	:	IL
Zip	:	61834-4509
Country	:	US
Telephone Number	:	855-925-4733
Fax Number	:	217-709-2345

Provider Business Practice Location Address
First Line	:	4905 W TROPICANA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103
Country	:	US
Telephone Number	:	855-925-4733
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANGELA BOWER
Credential	:
Telephone Number	:	855-925-4733

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	06/22/2018

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