MEDICARE: MR. JAMES A ARCHIE JR.

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	103K00000X	Behavior Analyst		NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700175098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES A ARCHIE JR.

Provider Business Mailing Address
First Line	:	7100 W ALEXANDER RD
Second Line	:	APT 2100
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6596
Country	:	US
Telephone Number	:	702-764-2193
Fax Number	:

Provider Business Practice Location Address
First Line	:	7100 W ALEXANDER RD
Second Line	:	APT 2100
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6596
Country	:	US
Telephone Number	:	702-764-2193
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2011
Last Update Date	:	04/07/2011

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