MEDICARE: ELECTRONIC TAX CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	104100000X	Social Worker
2	174400000X	Specialist
3	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1679196414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELECTRONIC TAX CENTER

Provider Business Mailing Address
First Line	:	3450 TANTO CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5047
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 TANTO CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5047
Country	:	US
Telephone Number	:	702-731-0556
Fax Number	:

Authorized Official
Title or Position	:	AGENT
Name	:	PEGGY NEWMAN
Credential	:
Telephone Number	:	702-731-0556

Provider Enumeration Date	:	05/27/2020
Last Update Date	:	05/27/2020

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Directions to “ELECTRONIC TAX CENTER ” Practice Location

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