Provider Demographics
NPI:1518037142
Name:BREAST HEALTH MEDICAL SERVICES PLLC
Entity Type:Organization
Organization Name:BREAST HEALTH MEDICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SOUZAN
Authorized Official - Middle Name:EZZAT
Authorized Official - Last Name:EL-EID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-255-1133
Mailing Address - Street 1:400 N STEPHANIE ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6676
Mailing Address - Country:US
Mailing Address - Phone:702-255-1133
Mailing Address - Fax:702-255-0582
Practice Address - Street 1:8285 W ARBY AVE STE 231
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2236
Practice Address - Country:US
Practice Address - Phone:702-255-1133
Practice Address - Fax:702-255-0582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01739959Medicaid
NYG25172Medicare UPIN
NY01739959Medicaid