MEDICARE: ELITE MEDICAL SERVICES

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	207P00000X	Emergency Medicine Physician	152198	NV

General Provider Information

NPI Number	:	1881916963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	2779 SUNRIDGE HEIGHTS PKWY
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-5050
Country	:	US
Telephone Number	:	702-565-9355
Fax Number	:	702-478-5480

Provider Business Practice Location Address
First Line	:	2779 SUNRIDGE HEIGHTS PKWY
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-5050
Country	:	US
Telephone Number	:	702-565-9355
Fax Number	:	702-478-5480

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SIMONG YOUMANS
Credential	:	M.D.
Telephone Number	:	702-565-9355

Provider Enumeration Date	:	02/17/2010
Last Update Date	:	02/17/2010

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