MEDICARE: ASPIRE MEDICAL CENTER 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	261QM2500X	Medical Specialty Clinic/Center
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1851153027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPIRE MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	6870 S RAINBOW BLVD STE 107
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2107
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6870 S RAINBOW BLVD STE 106-107
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2106
Country	:	US
Telephone Number	:	702-750-0659
Fax Number	:

Authorized Official
Title or Position	:	CHIEF MEDICAL DIRECTOR
Name	:	DR. MAI VI HA HOANG
Credential	:	MD
Telephone Number	:	702-750-0659

Provider Enumeration Date	:	01/24/2024
Last Update Date	:	04/01/2024

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