MEDICARE: P.M.O.S. 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	251S00000X	Community/Behavioral Health Agency	20111752195	NV

General Provider Information

NPI Number	:	1295004869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	P.M.O.S. LLC

Provider Business Mailing Address
First Line	:	2975 PAY LESS CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-7443
Country	:	US
Telephone Number	:	702-576-2446
Fax Number	:	866-929-4542

Provider Business Practice Location Address
First Line	:	2975 PAY LESS CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-7443
Country	:	US
Telephone Number	:	702-576-2446
Fax Number	:	866-929-4542

Authorized Official
Title or Position	:	CEO
Name	:	MR. ROBERT L.H. COGMON
Credential	:
Telephone Number	:	702-576-2446

Provider Enumeration Date	:	12/27/2011
Last Update Date	:	12/27/2011

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