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NPI Code Detail

MEDICARE: NEVADA ASSOCIATION OF CRITICAL CARE SURGEONS, LTD

MEDICARE: NEVADA ASSOCIATION OF CRITICAL CARE SURGEONS, LTD
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
1208600000XSurgery Physician5717NV
22086S0102XSurgical Critical Care Physician5717NV
32086S0127XTrauma Surgery Physician5717NV

General Provider Information

NPI Number : 1184796054
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEVADA ASSOCIATION OF CRITICAL CARE SURGEONS, LTD
Provider Business Mailing Address
First Line : PO BOX 270609
Second Line :
City : LAS VEGAS
State : NV
Zip : 89127-4609
Country : US
Telephone Number : 702-382-5343
Fax Number : 702-388-2922
Provider Business Practice Location Address
First Line : 501 S RANCHO DR
Second Line : SUITE E 32
City : LAS VEGAS
State : NV
Zip : 89106-4833
Country : US
Telephone Number : 702-382-5343
Fax Number : 702-388-2922
Authorized Official
Title or Position : CEO
Name : JAMES SHERMAN TATE JR.
Credential : MD
Telephone Number : 702-382-5343
Provider Enumeration Date : 11/15/2006
Last Update Date : 04/14/2008

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Directions to “NEVADA ASSOCIATION OF CRITICAL CARE SURGEONS, LTD ” Practice Location

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