MEDICARE: AVIS INGRAM

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	146D00000X	Personal Emergency Response Attendant		NV

General Provider Information

NPI Number	:	1831563394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVIS INGRAM

Provider Business Mailing Address
First Line	:	3793 WINTER WHITETAIL ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-3616
Country	:	US
Telephone Number	:	702-845-9887
Fax Number	:

Provider Business Practice Location Address
First Line	:	3793 WINTER WHITETAIL ST
Second Line	:	3793 WINTER WHITETAIL ST
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-3616
Country	:	US
Telephone Number	:	702-845-9887
Fax Number	:

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

Provider Enumeration Date	:	11/20/2015
Last Update Date	:	11/20/2015

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Directions to “ AVIS INGRAM ” Practice Location

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