MEDICARE: THALGOTT, A PROFESSIONAL CORPORATION

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	207XS0117X	Orthopaedic Surgery of the Spine Physician	5357	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CE0313	OTHER	NV	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01259773	OTHER	NV	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265532196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THALGOTT, A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	600 S RANCHO DR
Second Line	:	#107
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4806
Country	:	US
Telephone Number	:	702-878-8370
Fax Number	:	702-878-9364

Provider Business Practice Location Address
First Line	:	600 S RANCHO DR
Second Line	:	#107
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4806
Country	:	US
Telephone Number	:	702-878-8370
Fax Number	:	702-878-9364

Authorized Official
Title or Position	:	MD
Name	:	JOHN S THALGOTT
Credential	:
Telephone Number	:	702-878-8370

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	02/07/2019

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Directions to “THALGOTT, A PROFESSIONAL CORPORATION ” Practice Location

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