MEDICARE: CLINIC 21 OF NEVADA ZYNIEWICZ PLLC

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	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1437548906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINIC 21 OF NEVADA ZYNIEWICZ PLLC

Provider Business Mailing Address
First Line	:	4535 DRESSLER RD NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-2545
Country	:	US
Telephone Number	:	330-493-4443
Fax Number	:	330-493-8677

Provider Business Practice Location Address
First Line	:	5216 BOULDER HWY
Second Line	:	SUITE 105
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-6074
Country	:	US
Telephone Number	:	330-493-4443
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THOMAS ZYNIEWICZ
Credential	:	DO
Telephone Number	:	330-493-4443

Provider Enumeration Date	:	01/21/2015
Last Update Date	:	08/06/2015

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