Provider Demographics
NPI:1083253843
Name:DIMURO PROFESSIONAL SERVICES LLC
Entity Type:Organization
Organization Name:DIMURO PROFESSIONAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:DIMURO
Authorized Official - Suffix:
Authorized Official - Credentials:DO, MBA
Authorized Official - Phone:775-842-5742
Mailing Address - Street 1:DIMURO PAIN MANAGEMENT
Mailing Address - Street 2:3970 W ANN RD STE 100
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031
Mailing Address - Country:US
Mailing Address - Phone:702-747-4799
Mailing Address - Fax:702-747-4667
Practice Address - Street 1:DIMURO PAIN MANAGEMENT
Practice Address - Street 2:3970 W ANN RD STE 100
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031
Practice Address - Country:US
Practice Address - Phone:702-747-4799
Practice Address - Fax:702-747-4667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty