Provider Demographics
NPI:1477089746
Name:HOSPITALITY GROUP
Entity Type:Organization
Organization Name:HOSPITALITY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANUKYA
Authorized Official - Middle Name:
Authorized Official - Last Name:DASARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-800-8988
Mailing Address - Street 1:3175 SAINT ROSE PKWY
Mailing Address - Street 2:SUITE 230
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3506
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3175 SAINT ROSE PKWY
Practice Address - Street 2:SUITE 230
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3506
Practice Address - Country:US
Practice Address - Phone:702-602-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16426208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty