MEDICARE: PACIFIC WEST UROLOGY LLC, A PROFESSIONAL MEDICAL COMPANY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1114782596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC WEST UROLOGY LLC, A PROFESSIONAL MEDICAL COMPANY

Provider Business Mailing Address
First Line	:	4425 S PECOS RD STE 3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5039
Country	:	US
Telephone Number	:	725-225-5575
Fax Number	:	833-941-2450

Provider Business Practice Location Address
First Line	:	4425 S PECOS RD STE 3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5039
Country	:	US
Telephone Number	:	725-225-5575
Fax Number	:	833-941-2450

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. JOEL ABBOTT
Credential	:	DO
Telephone Number	:	702-715-4155

Provider Enumeration Date	:	02/15/2024
Last Update Date	:	02/15/2024

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