MEDICARE: NEVADA MEDICAL SYSTEMS, INC.

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	261QM2800X	Methadone Clinic	1938NTC-10	NV
2	261QM2800X	Methadone Clinic		NV

Other Identifiers

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

General Provider Information

NPI Number	:	1043393309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA MEDICAL SYSTEMS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 897
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83701
Country	:	US
Telephone Number	:	702-399-1600
Fax Number	:	702-399-5375

Provider Business Practice Location Address
First Line	:	2516 E LAKE MEAD BLVD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-6414
Country	:	US
Telephone Number	:	702-399-1600
Fax Number	:	702-399-5375

Authorized Official
Title or Position	:	OWNER
Name	:	MR. BRANT MASSMAN
Credential	:
Telephone Number	:	702-399-1600

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	06/06/2011

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