MEDICARE: MOYER MEDICAL GROUP

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1174167746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOYER MEDICAL GROUP

Provider Business Mailing Address
First Line	:	11459 OPAL SPRINGS WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-3421
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 E TROPICANA AVE STE 163
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6516
Country	:	US
Telephone Number	:	702-856-6838
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	JOSHUA MOYER
Credential	:	APRN-BC
Telephone Number	:	702-856-6838

Provider Enumeration Date	:	11/06/2019
Last Update Date	:	11/06/2019

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