MEDICARE: INGHAM NEUROSCIENCE GROUP LLC

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	208100000X	Physical Medicine & Rehabilitation Physician	10462	NV
2	2084N0400X	Neurology Physician	8804	NV

General Provider Information

NPI Number	:	1437443934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INGHAM NEUROSCIENCE GROUP LLC

Provider Business Mailing Address
First Line	:	2940 S JONES BLVD STE E
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5630
Country	:	US
Telephone Number	:	702-227-6947
Fax Number	:	702-247-4319

Provider Business Practice Location Address
First Line	:	2940 S JONES BLVD STE E
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5630
Country	:	US
Telephone Number	:	702-227-6947
Fax Number	:	702-247-4319

Authorized Official
Title or Position	:	MANAGER
Name	:	ROBERT H INGHAM
Credential	:	M.D.
Telephone Number	:	702-227-6947

Provider Enumeration Date	:	06/02/2011
Last Update Date	:	01/11/2019

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Directions to “INGHAM NEUROSCIENCE GROUP LLC ” Practice Location

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