MEDICARE: UNIVERSITY OF NV SCHOOL OF MEDICINE MULTI SPECIALTY GROUP PRACTICE SO

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	208000000X	Pediatrics Physician
2	2084N0400X	Neurology Physician
3	208600000X	Surgery Physician
4	261QM1300X	Multi-Specialty Clinic/Center
5	291U00000X	Clinical Medical Laboratory
6	133NN1002X	Nutrition Education Nutritionist
7	170300000X	Genetic Counselor (M.S.)
8	207Q00000X	Family Medicine Physician
9	207SG0201X	Clinical Genetics (M.D.) Physician
10	207SG0205X	Ph.D. Medical Genetics Physician
11	207V00000X	Obstetrics & Gynecology Physician
12	367A00000X	Advanced Practice Midwife	NV
13	363L00000X	Nurse Practitioner	NV
14	207R00000X	Internal Medicine Physician

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1184601239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF NV SCHOOL OF MEDICINE MULTI SPECIALTY GROUP PRACTICE SO

Provider Business Mailing Address
First Line	:	PO BOX 29506
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89126-9506
Country	:	US
Telephone Number	:	702-671-2330
Fax Number	:	702-671-5170

Provider Business Practice Location Address
First Line	:	1701 W CHARLESTON BLVD
Second Line	:	#110
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2325
Country	:	US
Telephone Number	:	702-671-2395
Fax Number	:	702-382-5388

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELISSA J. PALMER
Credential	:	M.D.
Telephone Number	:	702-992-6888

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	10/14/2015

1701 W CHARLESTON BLVD STE 440
LAS VEGAS, NV
89102-2325

Practice Phone: 702-671-2272
Practice Fax: 702-671-2701