MEDICARE: CHW NEVADA IMAGING COMPANY LLC

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	261QR0206X	Mammography Clinic/Center

General Provider Information

NPI Number	:	1285887091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHW NEVADA IMAGING COMPANY LLC

Provider Business Mailing Address
First Line	:	5495 S RAINBOW BLVD
Second Line	:	SUITE 101
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1871
Country	:	US
Telephone Number	:	702-317-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1818 E LAKE MEAD BLVD
Second Line	:	SUITE 113N
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7100
Country	:	US
Telephone Number	:	702-891-9729
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROD A. DAVIS
Credential	:
Telephone Number	:	702-616-5500

Provider Enumeration Date	:	10/24/2008
Last Update Date	:	10/24/2008

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