MEDICARE: NEVADA CARDIOLOGY PROFESSIONAL ASSN

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	207RC0000X	Cardiovascular Disease Physician	175317600	NV

General Provider Information

NPI Number	:	1134122021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA CARDIOLOGY PROFESSIONAL ASSN

Provider Business Mailing Address
First Line	:	3121 S MARYLAND PKWY
Second Line	:	STE 512
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-2310
Country	:	US
Telephone Number	:	702-796-7150
Fax Number	:	702-796-9071

Provider Business Practice Location Address
First Line	:	3121 S MARYLAND PKWY
Second Line	:	STE 512
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-2310
Country	:	US
Telephone Number	:	702-796-7150
Fax Number	:	702-796-9071

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	PETRA SALYER
Credential	:
Telephone Number	:	702-233-1000

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	08/27/2014

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