MEDICARE: SEASONS HEALTHCARE, INC.

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	207RG0100X	Gastroenterology Physician
2	208M00000X	Hospitalist Physician

General Provider Information

NPI Number	:	1902403793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEASONS HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 778413
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89077-8413
Country	:	US
Telephone Number	:	702-357-8811
Fax Number	:	702-947-5352

Provider Business Practice Location Address
First Line	:	6467 CARMEL CREEK AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-7021
Country	:	US
Telephone Number	:	248-974-1350
Fax Number	:	702-947-5352

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	JILL LEVY
Credential	:
Telephone Number	:	702-899-4509

Provider Enumeration Date	:	10/05/2020
Last Update Date	:	05/01/2023

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Directions to “SEASONS HEALTHCARE, INC. ” Practice Location

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