MEDICARE: SANTA FE MANAGEMENT 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	261QE0002X	Emergency Care Clinic/Center	12464	NV
2	261Q00000X	Clinic/Center	12464	NV

General Provider Information

NPI Number	:	1437534534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA FE MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	2828 E LAKE MEAD BLVD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-6550
Country	:	US
Telephone Number	:	702-218-1142
Fax Number	:	702-224-2104

Provider Business Practice Location Address
First Line	:	2828 E LAKE MEAD BLVD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-6550
Country	:	US
Telephone Number	:	702-218-1142
Fax Number	:	702-224-2104

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. MIGUEL ANGEL VARGAS
Credential	:	M.D., P.C.
Telephone Number	:	702-218-1142

Provider Enumeration Date	:	07/30/2015
Last Update Date	:	07/30/2015

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Directions to “SANTA FE MANAGEMENT LLC ” Practice Location

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