MEDICARE: DIAGNOSTIC CENTER OF MEDICINE (ALLEN) LLP

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	207Q00000X	Family Medicine Physician		NV
2	207R00000X	Internal Medicine Physician		NV

General Provider Information

NPI Number	:	1922043900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAGNOSTIC CENTER OF MEDICINE (ALLEN) LLP

Provider Business Mailing Address
First Line	:	5915 S RAINBOW BLVD STE 105
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2558
Country	:	US
Telephone Number	:	702-366-0640
Fax Number	:	702-366-9672

Provider Business Practice Location Address
First Line	:	5915 S RAINBOW BLVD STE 105
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2558
Country	:	US
Telephone Number	:	702-366-0640
Fax Number	:	702-366-9672

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	CHERYL MISKECH
Credential	:
Telephone Number	:	702-366-0640

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	05/06/2022

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