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NPI Code Detail

MEDICARE: JEREMY LIPSHUTZ, MD, PLLC

MEDICARE: JEREMY LIPSHUTZ, MD, PLLC
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
1207LA0401XAddiction Medicine (Anesthesiology) Physician
2207LP2900XPain Medicine (Anesthesiology) Physician
3208VP0014XInterventional Pain Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1NV20201887338OTHERNVNEVADA STATE BUSINESS LICENSE

General Provider Information

NPI Number : 1376159293
Entity Type Code : Organization
Provider Name (Legal Business Name) : JEREMY LIPSHUTZ, MD, PLLC
Provider Business Mailing Address
First Line : 6120 S FORT APACHE RD STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-6760
Country : US
Telephone Number : 702-948-8660
Fax Number : 702-948-8641
Provider Business Practice Location Address
First Line : 6120 S FORT APACHE RD STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-6760
Country : US
Telephone Number : 702-948-8660
Fax Number : 702-948-8641
Authorized Official
Title or Position : DIR OF OPERATIONS
Name : AMY MECHAM
Credential :
Telephone Number : 702-948-8660
Provider Enumeration Date : 09/16/2020
Last Update Date : 11/30/2020

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