MEDICARE: QUALITY MEDICAL IMAGING OF NEVADA 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	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	630001670	OTHER	NV	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295992998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY MEDICAL IMAGING OF NEVADA LLC

Provider Business Mailing Address
First Line	:	2490 PROFESSIONAL CT
Second Line	:	STE 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0835
Country	:	US
Telephone Number	:	702-839-1133
Fax Number	:	702-851-1616

Provider Business Practice Location Address
First Line	:	2490 PROFESSIONAL CT
Second Line	:	STE 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0835
Country	:	US
Telephone Number	:	702-839-1133
Fax Number	:	702-851-1616

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROGER CARL FASELT
Credential	:
Telephone Number	:	702-839-1133

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	05/26/2016

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