MEDICARE: AMERICAN ARTHRITIS RHEUMATOLOGY ASSOCIATES KELLY NV PLLC

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	207RR0500X	Rheumatology Physician

General Provider Information

NPI Number	:	1659928315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN ARTHRITIS RHEUMATOLOGY ASSOCIATES KELLY NV PLLC

Provider Business Mailing Address
First Line	:	2255 GLADES RD STE 228W
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33431-7391
Country	:	US
Telephone Number	:	561-699-7101
Fax Number	:	561-699-7101

Provider Business Practice Location Address
First Line	:	7200 CATHEDRAL ROCK DR STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0439
Country	:	US
Telephone Number	:	702-341-5444
Fax Number	:	702-341-5445

Authorized Official
Title or Position	:	EVP
Name	:	MS. KATHRYN GARRETT
Credential	:
Telephone Number	:	561-699-7101

Provider Enumeration Date	:	08/19/2019
Last Update Date	:	08/19/2019

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