MEDICARE: LAS VEGAS RADIOLOGISTS, 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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1275578080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS VEGAS RADIOLOGISTS, INC.

Provider Business Mailing Address
First Line	:	1551 CORONA HILL CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-5877
Country	:	US
Telephone Number	:	702-526-9127
Fax Number	:	702-896-1086

Provider Business Practice Location Address
First Line	:	2650 N TENAYA WAY
Second Line	:	SUITE 160
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1102
Country	:	US
Telephone Number	:	702-952-3640
Fax Number	:	702-952-3699

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALICE HUNG POON-CHUE
Credential	:	M.D.
Telephone Number	:	702-526-9127

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	08/22/2020

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