MEDICARE: ANTHONY BYRD

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1700387412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY BYRD

Provider Business Mailing Address
First Line	:	6674 BRICK HOUSE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-8617
Country	:	US
Telephone Number	:	702-444-9838
Fax Number	:

Provider Business Practice Location Address
First Line	:	2650 S JONES BLVD STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5341
Country	:	US
Telephone Number	:	702-214-2190
Fax Number	:

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

Provider Enumeration Date	:	02/27/2018
Last Update Date	:	02/27/2018

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Directions to “ ANTHONY BYRD ” Practice Location

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