MEDICARE: UNIVERSITY OF NV SCHOOL OF MEDICINE MULTI SPECIALTY GROUP PRACTICE SO

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	207SC0300X	Clinical Cytogenetics Physician
2	207SG0201X	Clinical Genetics (M.D.) Physician

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	:	1477686004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF NV SCHOOL OF MEDICINE MULTI SPECIALTY GROUP PRACTICE SO

Provider Business Mailing Address
First Line	:	PO BOX 29506
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89126-9506
Country	:	US
Telephone Number	:	702-696-8437
Fax Number	:	702-671-5170

Provider Business Practice Location Address
First Line	:	522 E TWAIN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-4905
Country	:	US
Telephone Number	:	702-671-2200
Fax Number	:	702-671-2233

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELISSA J. PALMER
Credential	:	MD
Telephone Number	:	702-992-6888

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	10/14/2015

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