Provider Demographics
NPI:1619596806
Name:PACIFIC WEST UROLOGY LLC, A PROFESSIONAL MEDICAL COMPANY
Entity Type:Organization
Organization Name:PACIFIC WEST UROLOGY LLC, A PROFESSIONAL MEDICAL COMPANY
Other - Org Name:JOEL ABBOTT DO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:725-225-5575
Mailing Address - Street 1:4425 S PECOS RD STE 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5039
Mailing Address - Country:US
Mailing Address - Phone:725-225-5575
Mailing Address - Fax:833-941-2450
Practice Address - Street 1:4425 S PECOS RD STE 3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5039
Practice Address - Country:US
Practice Address - Phone:725-225-5575
Practice Address - Fax:833-941-2450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty