Provider Demographics
NPI:1164705547
Name:PAHRUMP GASTROENTEROLOGY LLC
Entity Type:Organization
Organization Name:PAHRUMP GASTROENTEROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OSAMA
Authorized Official - Middle Name:OMAR
Authorized Official - Last Name:HAIKAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-734-0505
Mailing Address - Street 1:2136 E DESERT INN RD
Mailing Address - Street 2:STE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3247
Mailing Address - Country:US
Mailing Address - Phone:702-734-0505
Mailing Address - Fax:702-734-3912
Practice Address - Street 1:360 S LOLA LN
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-0884
Practice Address - Country:US
Practice Address - Phone:775-751-7580
Practice Address - Fax:775-751-7820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20111561669174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty