Provider Demographics
NPI:1376159293
Name:JEREMY LIPSHUTZ, MD, PLLC
Entity Type:Organization
Organization Name:JEREMY LIPSHUTZ, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MECHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-948-8660
Mailing Address - Street 1:6120 S FORT APACHE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-6760
Mailing Address - Country:US
Mailing Address - Phone:702-948-8660
Mailing Address - Fax:702-948-8641
Practice Address - Street 1:6120 S FORT APACHE RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-6760
Practice Address - Country:US
Practice Address - Phone:702-948-8660
Practice Address - Fax:702-948-8641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-16
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV20201887338OtherNEVADA STATE BUSINESS LICENSE