MEDICARE: RIFLEY INSTITUTE OF COSMETIC SURGERY

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	332900000X	Non-Pharmacy Dispensing Site	7465	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2989993	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1639180276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIFLEY INSTITUTE OF COSMETIC SURGERY

Provider Business Mailing Address
First Line	:	2800 N TENAYA WAY
Second Line	:	STE 201
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0652
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 N TENAYA WAY
Second Line	:	STE 201
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0652
Country	:	US
Telephone Number	:	702-242-4616
Fax Number	:	702-243-9219

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	WILLIAM RIFLEY
Credential	:	NMI
Telephone Number	:	702-242-4616

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	08/22/2020

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