MEDICARE: SILVER STATE HEALTH SERVICES

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1356806061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVER STATE HEALTH SERVICES

Provider Business Mailing Address
First Line	:	2215C RENAISSANCE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6729
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2215C RENAISSANCE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6729
Country	:	US
Telephone Number	:	702-471-0420
Fax Number	:	702-471-0420

Authorized Official
Title or Position	:	COO
Name	:	PAULINE MAH
Credential	:
Telephone Number	:	702-471-0420

Provider Enumeration Date	:	02/06/2019
Last Update Date	:	03/31/2022

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