Provider Demographics
NPI:1568410272
Name:ENDOSCOPIC INSTITUTE OF NEVADA
Entity Type:Organization
Organization Name:ENDOSCOPIC INSTITUTE OF NEVADA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:KWOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-699-5622
Mailing Address - Street 1:PO BOX 50652
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89016-0652
Mailing Address - Country:US
Mailing Address - Phone:702-699-5622
Mailing Address - Fax:702-796-5211
Practice Address - Street 1:3777 PECOS MCLEOD
Practice Address - Street 2:SUITE 102
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-4264
Practice Address - Country:US
Practice Address - Phone:702-699-5622
Practice Address - Fax:702-796-5211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV471ASC-9261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy