MEDICARE: NORTH VISTA PHYSICIANS, 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	207XS0117X	Orthopaedic Surgery of the Spine Physician	NV 13268	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912277641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH VISTA PHYSICIANS, INC.

Provider Business Mailing Address
First Line	:	1409 E LAKE MEAD BLVD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7120
Country	:	US
Telephone Number	:	702-649-7711
Fax Number	:

Provider Business Practice Location Address
First Line	:	1815 E LAKE MEAD BLVD
Second Line	:	SUITE 100
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7187
Country	:	US
Telephone Number	:	702-657-1506
Fax Number	:	702-657-1583

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	VINCENZO VARIALE
Credential	:
Telephone Number	:	702-649-7711

Provider Enumeration Date	:	01/11/2012
Last Update Date	:	03/17/2016

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