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NPI Code Detail

MEDICARE: DANIEL E MATHIS

MEDICARE: DANIEL E MATHIS
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
1376G00000XNursing Home Administrator310NV

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 : 1982372645
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL E MATHIS
Provider Business Mailing Address
First Line : 2496 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-2179
Country : US
Telephone Number : 702-310-3722
Fax Number : 702-310-3722
Provider Business Practice Location Address
First Line : 2496 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-2179
Country : US
Telephone Number : 702-310-3722
Fax Number : 702-310-3722
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2021
Last Update Date : 08/30/2021

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Directions to “ DANIEL E MATHIS ” Practice Location

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