MEDICARE: COPELAND - BEAJOW MEDICAL INSTITUTE, CHTD

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1871542530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COPELAND - BEAJOW MEDICAL INSTITUTE, CHTD

Provider Business Mailing Address
First Line	:	7365 PRAIRIE FALCON RD
Second Line	:	SUITE 150
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0808
Country	:	US
Telephone Number	:	702-792-4336
Fax Number	:	702-202-3455

Provider Business Practice Location Address
First Line	:	7365 PRAIRIE FALCON RD
Second Line	:	SUITE 150
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0808
Country	:	US
Telephone Number	:	702-792-4336
Fax Number	:	702-202-3455

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	STEPHEN CONNORS
Credential	:
Telephone Number	:	702-792-4336

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	10/30/2014

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