MEDICARE: MOUNTAIN PODIATRY

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	213E00000X	Podiatrist	9811	NV

General Provider Information

NPI Number	:	1710129549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN PODIATRY

Provider Business Mailing Address
First Line	:	653 N TOWN CENTER DR STE 118
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-0515
Country	:	US
Telephone Number	:	702-240-8038
Fax Number	:	702-240-2256

Provider Business Practice Location Address
First Line	:	653 N TOWN CENTER DR STE 118
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-0515
Country	:	US
Telephone Number	:	702-240-8038
Fax Number	:	702-240-2256

Authorized Official
Title or Position	:	OWNER
Name	:	MS. JODI S POLITZ
Credential	:	PDM
Telephone Number	:	702-240-8038

Provider Enumeration Date	:	03/25/2009
Last Update Date	:	03/25/2009

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Directions to “MOUNTAIN PODIATRY ” Practice Location

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