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NPI Code Detail

MEDICARE: ALTON JAMES TATE

MEDICARE: ALTON JAMES TATE
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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1619218674
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALTON JAMES TATE
Provider Business Mailing Address
First Line : 1200 BARTON GREEN DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-1680
Country : US
Telephone Number : 702-502-7606
Fax Number :
Provider Business Practice Location Address
First Line : 2298 W HORIZON RIDGE PKWY STE 201
Second Line :
City : HENDERSON
State : NV
Zip : 89052-2698
Country : US
Telephone Number : 702-363-7284
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2013
Last Update Date : 03/14/2013

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