MEDICARE: CLINICS IN SCHOOLS OF NEVADA

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	261QP2300X	Primary Care Clinic/Center	10452	NV

General Provider Information

NPI Number	:	1275763641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICS IN SCHOOLS OF NEVADA

Provider Business Mailing Address
First Line	:	350 JUDSON AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-5671
Country	:	US
Telephone Number	:	702-855-9219
Fax Number	:	702-855-9220

Provider Business Practice Location Address
First Line	:	350 JUDSON AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-5671
Country	:	US
Telephone Number	:	702-855-9219
Fax Number	:	702-855-9220

Authorized Official
Title or Position	:	MEDICAL/EXECUTIVE DIRECTOR
Name	:	DR. NOAH B. KOHN
Credential	:	MD
Telephone Number	:	702-855-9219

Provider Enumeration Date	:	07/20/2009
Last Update Date	:	07/20/2009

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