MEDICARE: BHATNAGAR PROSTATE CANCER INSTITUTE OF NEVADA PC

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	2085R0001X	Radiation Oncology Physician

General Provider Information

NPI Number	:	1801664347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BHATNAGAR PROSTATE CANCER INSTITUTE OF NEVADA PC

Provider Business Mailing Address
First Line	:	PO BOX 15088
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85060-5088
Country	:	US
Telephone Number	:	702-553-4901
Fax Number	:	702-553-4902

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	:	702-553-4901
Fax Number	:	702-553-4902

Authorized Official
Title or Position	:	OWNER AND PHYSICIAN
Name	:	AJAY BHATNAGAR
Credential	:
Telephone Number	:	702-553-4901

Provider Enumeration Date	:	12/14/2023
Last Update Date	:	01/12/2024

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