MEDICARE: AIRPORT MD - LAS VEGAS

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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1013249481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AIRPORT MD - LAS VEGAS

Provider Business Mailing Address
First Line	:	5757 WAYNE NEWTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89111-5000
Country	:	US
Telephone Number	:	702-261-4622
Fax Number	:

Provider Business Practice Location Address
First Line	:	5757 WAYNE NEWTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89111-5000
Country	:	US
Telephone Number	:	702-261-4622
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JODI VANCE
Credential	:
Telephone Number	:	651-439-8484

Provider Enumeration Date	:	02/09/2010
Last Update Date	:	02/10/2010

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Directions to “AIRPORT MD - LAS VEGAS ” Practice Location

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