Provider Demographics
NPI:1063534923
Name:LAS VEGAS RADIOLOGY LLC
Entity type:Organization
Organization Name:LAS VEGAS RADIOLOGY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PREM
Authorized Official - Middle Name:K
Authorized Official - Last Name:KITTUSAMY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-254-5004
Mailing Address - Street 1:9811 W CHARLESTON BLVD
Mailing Address - Street 2:#2542
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7528
Mailing Address - Country:US
Mailing Address - Phone:702-254-5004
Mailing Address - Fax:702-432-4005
Practice Address - Street 1:7500 SMOKE RANCH RD.
Practice Address - Street 2:STE. 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:702-254-5004
Practice Address - Fax:702-432-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPENDING2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty