MEDICARE: MAI FAMILY HEALTH CLINIC LLC

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	363L00000X	Nurse Practitioner		NV
2	363LF0000X	Family Nurse Practitioner		NV

General Provider Information

NPI Number	:	1669852042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAI FAMILY HEALTH CLINIC LLC

Provider Business Mailing Address
First Line	:	9315 W SUNSET RD
Second Line	:	100
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5011
Country	:	US
Telephone Number	:	702-480-2044
Fax Number	:	702-638-7706

Provider Business Practice Location Address
First Line	:	9315 W SUNSET RD
Second Line	:	100
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5011
Country	:	US
Telephone Number	:	702-480-2044
Fax Number	:	702-638-7706

Authorized Official
Title or Position	:	OWNER
Name	:	JESSE THI MAI
Credential	:	FNP
Telephone Number	:	702-480-2044

Provider Enumeration Date	:	06/01/2015
Last Update Date	:	06/01/2015

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