MEDICARE: PLATINUM SURGICAL ASSISTANTS OF LAS VEGAS

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	126800000X	Dental Assistant
2	156FX1101X	Ophthalmic Assistant	171630	NV
3	246ZC0007X	Surgical Assistant	171630
4	246ZS0410X	Surgical Technologist	171630	NV
5	246ZX2200X	Orthopedic Assistant	171630	NV
6	363AS0400X	Surgical Physician Assistant
7	246ZC0007X	Surgical Assistant	171630	NV

General Provider Information

NPI Number	:	1750827580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLATINUM SURGICAL ASSISTANTS OF LAS VEGAS

Provider Business Mailing Address
First Line	:	4140 INGLEWOOD POINT ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-1147
Country	:	US
Telephone Number	:	702-325-8928
Fax Number	:

Provider Business Practice Location Address
First Line	:	4140 INGLEWOOD POINT ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-1147
Country	:	US
Telephone Number	:	702-325-8928
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. VERN VONTRICE PALMER
Credential	:	CSFA
Telephone Number	:	702-325-8928

Provider Enumeration Date	:	01/18/2017
Last Update Date	:	01/18/2017

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Directions to “PLATINUM SURGICAL ASSISTANTS OF LAS VEGAS ” Practice Location

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