MEDICARE: FOOT AND LEG CENTERS OF NEVADA

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	213ES0103X	Foot & Ankle Surgery Podiatrist	0911	NV

General Provider Information

NPI Number	:	1316258817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT AND LEG CENTERS OF NEVADA

Provider Business Mailing Address
First Line	:	2251 S FORT APACHE RD
Second Line	:	SUITE NUMBER 2154
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5758
Country	:	US
Telephone Number	:	585-410-5275
Fax Number	:

Provider Business Practice Location Address
First Line	:	2251 S FORT APACHE RD
Second Line	:	SUITE NUMBER 2154
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5758
Country	:	US
Telephone Number	:	585-410-5275
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GEORGE ROBERT VITO
Credential	:	DPM
Telephone Number	:	585-410-5275

Provider Enumeration Date	:	06/29/2010
Last Update Date	:	06/29/2010

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