1295967784 NPI number — ROSNER P. LUSS MD LTD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295967784 NPI number — ROSNER P. LUSS MD LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSNER P. LUSS MD LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295967784
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1621 E FLAMINGO RD
Provider Second Line Business Mailing Address:
16B
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89119-5276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-696-0506
Provider Business Mailing Address Fax Number:
702-696-0532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1621 E FLAMINGO RD
Provider Second Line Business Practice Location Address:
16B
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89119-5276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-696-0506
Provider Business Practice Location Address Fax Number:
702-696-0532
Provider Enumeration Date:
08/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LUSS
Authorized Official First Name:
ROSNER
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
702-696-0506

Provider Taxonomy Codes

  • Taxonomy code: 173000000X , with the licence number:  8699 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 29D2033945 . This is a "CLIA" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 964206 . This is a "MEDICAID" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 002018068 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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