MEDICARE: DR. SIMON J. FARROW

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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1942948625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. SIMON J. FARROW

Provider Business Mailing Address
First Line	:	1000 N GREEN VALLEY PKWY # 440-493
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-6163
Country	:	US
Telephone Number	:	702-906-0027
Fax Number	:	702-906-0160

Provider Business Practice Location Address
First Line	:	5495 S RAINBOW BLVD STE 202
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1873
Country	:	US
Telephone Number	:	702-906-0027
Fax Number	:	702-906-0160

Authorized Official
Title or Position	:	PRESIDENT
Name	:	REBEKAH TRUMAN
Credential	:	MD
Telephone Number	:	702-906-0027

Provider Enumeration Date	:	05/23/2022
Last Update Date	:	08/30/2022

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