MEDICARE: VC SMITH, J E MARTIN, NANCY DONAHOE, DEMETRI K MAVROIDIS

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	282NC0060X	Critical Access Hospital	APN001394	NV
2	282N00000X	General Acute Care Hospital	APN001394	NV

General Provider Information

NPI Number	:	1598001786
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VC SMITH, J E MARTIN, NANCY DONAHOE, DEMETRI K MAVROIDIS

Provider Business Mailing Address
First Line	:	5320 S RAINBOW BLVD
Second Line	:	STE 282
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1895
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5320 S RAINBOW BLVD
Second Line	:	STE 282
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1895
Country	:	US
Telephone Number	:	702-737-3808
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MR. KEVIN PRICE
Credential	:	MBA
Telephone Number	:	702-737-3808

Provider Enumeration Date	:	12/17/2012
Last Update Date	:	12/17/2012

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