MEDICARE: RODERICK ANTHONY ADAMS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	171W00000X	Contractor
2	172V00000X	Community Health Worker
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1194009084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODERICK ANTHONY ADAMS

Provider Business Mailing Address
First Line	:	450 E TWAIN AVE
Second Line	:	92
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-4904
Country	:	US
Telephone Number	:	702-378-7785
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 E TWAIN AVE
Second Line	:	92
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-4904
Country	:	US
Telephone Number	:	702-378-7785
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2011
Last Update Date	:	10/18/2011

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