MEDICARE: WARNER SUPPORT CENTER CORP

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	207VG0400X	Gynecology Physician	9891	NV

General Provider Information

NPI Number	:	1093047920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WARNER SUPPORT CENTER CORP

Provider Business Mailing Address
First Line	:	8875 W FLAMINGO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-8730
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8875 W FLAMINGO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-8730
Country	:	US
Telephone Number	:	702-325-6421
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BRUCE S CRAWFORD
Credential	:
Telephone Number	:	702-325-6421

Provider Enumeration Date	:	02/03/2010
Last Update Date	:	02/03/2010

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