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NPI Code Detail

MEDICARE: RUCKDESCHEL MANNO, LTD. DBA

MEDICARE: RUCKDESCHEL MANNO, LTD. DBA
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
1261QX0203XRadiation Oncology Clinic/Center
2261QX0200XOncology Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number : 1922008523
Entity Type Code : Organization
Provider Name (Legal Business Name) : RUCKDESCHEL MANNO, LTD. DBA
Provider Business Mailing Address
First Line : PO BOX 98809
Second Line :
City : LAS VEGAS
State : NV
Zip : 89193-8809
Country : US
Telephone Number : 702-822-5433
Fax Number : 702-944-0471
Provider Business Practice Location Address
First Line : ONE BREAKTHROUGH WAY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89135-3011
Country : US
Telephone Number : 702-822-5433
Fax Number : 702-944-0471
Authorized Official
Title or Position : INTERIM DIRECTOR
Name : PHILLIP MANNO
Credential : M.D.
Telephone Number : 702-822-5433
Provider Enumeration Date : 07/26/2005
Last Update Date : 06/16/2011

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Directions to “RUCKDESCHEL MANNO, LTD. DBA ” Practice Location

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