MEDICARE: SANTA ROSA MEDICAL CENTERS 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	3336H0001X	Home Infusion Therapy Pharmacy
2	3336C0002X	Clinic Pharmacy

General Provider Information

NPI Number	:	1447982483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA ROSA MEDICAL CENTERS OF NEVADA, INC.

Provider Business Mailing Address
First Line	:	4161 S EASTERN AVE STE B3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5483
Country	:	US
Telephone Number	:	702-444-7940
Fax Number	:	702-989-4755

Provider Business Practice Location Address
First Line	:	6045 S RAINBOW BLVD STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2572
Country	:	US
Telephone Number	:	702-444-7940
Fax Number	:	702-989-4755

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	SYED IRSHAD PERVAIZ
Credential	:
Telephone Number	:	702-444-7940

Provider Enumeration Date	:	06/28/2022
Last Update Date	:	09/15/2022

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