MEDICARE: RABBITBRUSH HEALTHCARE

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	207Q00000X	Family Medicine Physician	9259	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V39444	OTHER	NV	MEDICARE GROUP NUMBER

General Provider Information

NPI Number	:	1245429737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RABBITBRUSH HEALTHCARE

Provider Business Mailing Address
First Line	:	PO BOX 660
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89702-0660
Country	:	US
Telephone Number	:	775-885-0919
Fax Number	:	775-885-0953

Provider Business Practice Location Address
First Line	:	200 BATH ST
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89703-2405
Country	:	US
Telephone Number	:	775-882-1400
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANTHONY T ZIMMERMAN
Credential	:	M.D.
Telephone Number	:	775-882-1400

Provider Enumeration Date	:	10/19/2007
Last Update Date	:	10/19/2007

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