MEDICARE: WOLFSON MEDICAL CENTER AT TENAYA

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	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1306076468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOLFSON MEDICAL CENTER AT TENAYA

Provider Business Mailing Address
First Line	:	10788 RIVENDELL AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-1803
Country	:	US
Telephone Number	:	702-363-9900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2655 BOX CANYON DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1119
Country	:	US
Telephone Number	:	702-363-9900
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ERIC WOLFSON
Credential	:	MD
Telephone Number	:	702-452-2526

Provider Enumeration Date	:	07/22/2009
Last Update Date	:	04/18/2016

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