MEDICARE: VAN GORDER & ASSOCIATES, INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies	NV20031517022	NV

General Provider Information

NPI Number	:	1184931768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VAN GORDER & ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	2470 N DECATUR BLVD
Second Line	:	SUITE 115
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-2981
Country	:	US
Telephone Number	:	702-869-8300
Fax Number	:	702-221-8308

Provider Business Practice Location Address
First Line	:	2470 N DECATUR BLVD
Second Line	:	SUITE 115
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-2981
Country	:	US
Telephone Number	:	702-869-8300
Fax Number	:	702-221-8308

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. LINDA JEAN VAN GORDER
Credential	:
Telephone Number	:	702-869-8300

Provider Enumeration Date	:	09/02/2010
Last Update Date	:	09/02/2010

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