MEDICARE: MPMD ANESTHESIOLOGY SERVICES LLC

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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1801434535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MPMD ANESTHESIOLOGY SERVICES LLC

Provider Business Mailing Address
First Line	:	10620 SOUTHERN HIGHLANDS PKWY # 110-250
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-4371
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 WELLNESS WAY STE 202
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4146
Country	:	US
Telephone Number	:	702-310-9110
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARYANNE PHILLIPS
Credential	:	MD
Telephone Number	:	702-860-8965

Provider Enumeration Date	:	12/12/2019
Last Update Date	:	12/12/2019

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