MEDICARE: SWANLAKE MEDICAL CENTER

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	207R00000X	Internal Medicine Physician	9484	NV
2	208000000X	Pediatrics Physician	8652	NV
3	207R00000X	Internal Medicine Physician	8652	NV

General Provider Information

NPI Number	:	1316169980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWANLAKE MEDICAL CENTER

Provider Business Mailing Address
First Line	:	3330 S HUALAPAI WAY
Second Line	:	SUITE #120
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7716
Country	:	US
Telephone Number	:	702-765-5253
Fax Number	:	702-765-5354

Provider Business Practice Location Address
First Line	:	3330 S HUALAPAI WAY
Second Line	:	SUITE #120
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7716
Country	:	US
Telephone Number	:	702-765-5253
Fax Number	:	702-765-5354

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VICTOR R BRUCE
Credential	:	MD
Telephone Number	:	702-765-5253

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	01/04/2010

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Directions to “SWANLAKE MEDICAL CENTER ” Practice Location

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