Provider Demographics
NPI:1629054994
Name:LAS VEGAS UROLOGY LLP
Entity Type:Organization
Organization Name:LAS VEGAS UROLOGY LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MNG MBR
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRIGORIEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-233-0727
Mailing Address - Street 1:7150 W SUNSET RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1982
Mailing Address - Country:US
Mailing Address - Phone:702-385-4342
Mailing Address - Fax:702-385-4346
Practice Address - Street 1:7150 W SUNSET RD STE 202B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-1981
Practice Address - Country:US
Practice Address - Phone:702-385-4342
Practice Address - Fax:702-385-4346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVVWJBHQMedicare PIN