1801664347 NPI number — BHATNAGAR PROSTATE CANCER INSTITUTE OF NEVADA PC

Table of content: (NPI 1063400968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801664347 NPI number — BHATNAGAR PROSTATE CANCER INSTITUTE OF NEVADA PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BHATNAGAR PROSTATE CANCER INSTITUTE OF NEVADA PC
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:
1801664347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15088
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85060-5088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-553-4901
Provider Business Mailing Address Fax Number:
702-553-4902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4425 S PECOS RD STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89121-5039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-553-4901
Provider Business Practice Location Address Fax Number:
702-553-4902
Provider Enumeration Date:
12/14/2023

Additional Information

Authorized Official

Authorized Official Last Name:
BHATNAGAR
Authorized Official First Name:
AJAY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER AND PHYSICIAN
Authorized Official Telephone Number:
702-553-4901

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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