Healthcare Provider Details

I. General information

NPI: 1376159293
Provider Name (Legal Business Name): JEREMY LIPSHUTZ, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6120 S FORT APACHE RD STE 100
LAS VEGAS NV
89148-6760
US

IV. Provider business mailing address

6120 S FORT APACHE RD STE 100
LAS VEGAS NV
89148-6760
US

V. Phone/Fax

Practice location:
  • Phone: 702-948-8660
  • Fax: 702-948-8641
Mailing address:
  • Phone: 702-948-8660
  • Fax: 702-948-8641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMY MECHAM
Title or Position: DIR OF OPERATIONS
Credential:
Phone: 702-948-8660