MEDICARE: NEVADA HEALTH CENTERS, 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	3336C0002X	Clinic Pharmacy	PH1212	NV

General Provider Information

NPI Number	:	1073797866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA HEALTH CENTERS, INC.

Provider Business Mailing Address
First Line	:	1802 N CARSON ST STE 100
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89701-1227
Country	:	US
Telephone Number	:	775-888-6610
Fax Number	:	775-887-7046

Provider Business Practice Location Address
First Line	:	1312 E TONOPAH AVE
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89030-7111
Country	:	US
Telephone Number	:	702-399-4791
Fax Number	:	702-399-1547

Authorized Official
Title or Position	:	PHARMACIST
Name	:	STEPHANIE INGREY
Credential	:	RPH
Telephone Number	:	775-888-6610

Provider Enumeration Date	:	12/28/2007
Last Update Date	:	12/28/2007

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