Provider Demographics
NPI:1780678383
Name:ENDOSCOPY CENTER OF SOUTHERN NEVADA, LLC
Entity Type:Organization
Organization Name:ENDOSCOPY CENTER OF SOUTHERN NEVADA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-382-8101
Mailing Address - Street 1:700 SHADOW LN
Mailing Address - Street 2:SUITE #165B
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4126
Mailing Address - Country:US
Mailing Address - Phone:702-380-0809
Mailing Address - Fax:702-382-4641
Practice Address - Street 1:700 SHADOW LN
Practice Address - Street 2:SUITE #165A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4126
Practice Address - Country:US
Practice Address - Phone:702-380-0809
Practice Address - Fax:702-382-4641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV472ASC9261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV36901Medicare ID - Type Unspecified