MEDICARE: WOMENS SPECIALTY CARE, LLLP

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	332900000X	Non-Pharmacy Dispensing Site	9040	NV

General Provider Information

NPI Number	:	1932477296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMENS SPECIALTY CARE, LLLP

Provider Business Mailing Address
First Line	:	5502 S FORT APACHE RD
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-7683
Country	:	US
Telephone Number	:	702-255-3547
Fax Number	:	702-921-2419

Provider Business Practice Location Address
First Line	:	10105 BANBURRY CROSS DR
Second Line	:	SUITE 460
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-6646
Country	:	US
Telephone Number	:	702-255-3547
Fax Number	:	702-255-3549

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. TAMMY ROSE KELLY
Credential	:	M.D.
Telephone Number	:	702-255-3547

Provider Enumeration Date	:	12/01/2011
Last Update Date	:	12/01/2011

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Directions to “WOMENS SPECIALTY CARE, LLLP ” Practice Location

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