MEDICARE: PORTEOUS UNITED SURGICAL ANESTHESIOLOGISTS, PLLC

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1922345594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORTEOUS UNITED SURGICAL ANESTHESIOLOGISTS, PLLC

Provider Business Mailing Address
First Line	:	7326 W CHEYENNE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6201
Country	:	US
Telephone Number	:	702-386-4700
Fax Number	:	702-386-4701

Provider Business Practice Location Address
First Line	:	2739 SUNRIDGE HEIGHTS PKWY
Second Line	:	STE 110
City	:	HENDERSON
State	:	NV
Zip	:	89052-5042
Country	:	US
Telephone Number	:	702-386-4700
Fax Number	:	702-386-4701

Authorized Official
Title or Position	:	OWNER
Name	:	GREGSON PORTEOUS
Credential	:	D.O.
Telephone Number	:	702-386-4700

Provider Enumeration Date	:	01/15/2013
Last Update Date	:	01/15/2013

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