MEDICARE: CHW NEVADA IMAGING COMPANY LLC

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	261QR0206X	Mammography Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00731251	OTHER	NV	RAILROAD

General Provider Information

NPI Number	:	1134372055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHW NEVADA IMAGING COMPANY LLC

Provider Business Mailing Address
First Line	:	2835 S JONES BLVD
Second Line	:	SUITE 3
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5354
Country	:	US
Telephone Number	:	702-597-1145
Fax Number	:

Provider Business Practice Location Address
First Line	:	5495 S RAINBOW BLVD
Second Line	:	SUITE 3
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1871
Country	:	US
Telephone Number	:	702-317-1200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROD A. DAVIS
Credential	:
Telephone Number	:	702-616-5500

Provider Enumeration Date	:	10/23/2008
Last Update Date	:	02/28/2013

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Directions to “CHW NEVADA IMAGING COMPANY LLC ” Practice Location

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