MEDICARE: FAMILY MEDICAL OF NEVADA, INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies	503621950	NV

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	:	1417940933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICAL OF NEVADA, INC.

Provider Business Mailing Address
First Line	:	4230 N PECOS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-0196
Country	:	US
Telephone Number	:	702-643-6639
Fax Number	:	702-643-0208

Provider Business Practice Location Address
First Line	:	4230 N PECOS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-0196
Country	:	US
Telephone Number	:	702-643-6639
Fax Number	:	702-643-0208

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. YOEL GARCIA GONZALEZ
Credential	:
Telephone Number	:	702-643-6639

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	08/07/2009

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