Provider Demographics
NPI:1891185096
Name:EZEANOLUE, MD, PRECISION SURGERY CENTER OF LAS VEGAS, PLLC
Entity Type:Organization
Organization Name:EZEANOLUE, MD, PRECISION SURGERY CENTER OF LAS VEGAS, PLLC
Other - Org Name:PRECISION SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOLUE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:EZEANOLUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-310-9110
Mailing Address - Street 1:1701 BEARDEN DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4189
Mailing Address - Country:US
Mailing Address - Phone:702-310-9110
Mailing Address - Fax:702-310-9114
Practice Address - Street 1:1701 BEARDEN DR
Practice Address - Street 2:SUITE 202
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4189
Practice Address - Country:US
Practice Address - Phone:702-310-9110
Practice Address - Fax:702-310-9114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20141278772261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPENDINGMedicaid
NVPENDINGMedicaid
PENDINGMedicare PIN