1568410272 NPI number — ENDOSCOPIC INSTITUTE OF NEVADA

Table of content: (NPI 1568410272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568410272 NPI number — ENDOSCOPIC INSTITUTE OF NEVADA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENDOSCOPIC INSTITUTE OF NEVADA
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:
1568410272
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 50652
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89016-0652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-699-5622
Provider Business Mailing Address Fax Number:
702-796-5211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3777 PECOS MCLEOD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89121-4264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-699-5622
Provider Business Practice Location Address Fax Number:
702-796-5211
Provider Enumeration Date:
05/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KWOK
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
MARTIN
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
702-699-5622

Provider Taxonomy Codes

  • Taxonomy code: 261QE0800X , with the licence number:  471ASC-9 , 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)





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