MEDICARE: CHURCHWRIGHT 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	103TC0700X	Clinical Psychologist	PY0528	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	FM420A	OTHER	NV	MEDICARE PTAN

General Provider Information

NPI Number	:	1588945158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHURCHWRIGHT INC

Provider Business Mailing Address
First Line	:	8275 S EASTERN AVE
Second Line	:	SUITE 113
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2591
Country	:	US
Telephone Number	:	702-530-1141
Fax Number	:	702-938-1023

Provider Business Practice Location Address
First Line	:	8275 S EASTERN AVE
Second Line	:	SUITE 113
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2591
Country	:	US
Telephone Number	:	702-530-1141
Fax Number	:	702-938-1023

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CINDY SCHMIDT
Credential	:	PH.D.
Telephone Number	:	702-530-1141

Provider Enumeration Date	:	09/08/2011
Last Update Date	:	02/08/2012

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Directions to “CHURCHWRIGHT INC ” Practice Location

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