MEDICARE: MR. EYOB W ABRHA

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	343900000X	Non-emergency Medical Transport (VAN)	NV20232765212	NV

General Provider Information

NPI Number	:	1861180150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EYOB W ABRHA

Provider Business Mailing Address
First Line	:	6074 PIRATES DELIGHT AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6973
Country	:	US
Telephone Number	:	702-945-7474
Fax Number	:

Provider Business Practice Location Address
First Line	:	6074 PIRATES DELIGHT AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6973
Country	:	US
Telephone Number	:	702-945-7474
Fax Number	:

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

Provider Enumeration Date	:	04/26/2023
Last Update Date	:	05/20/2023

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