=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770476376
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAST RUSSELL SURGERY PARTNERS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2025
-----------------------------------------------------
Last Update Date | 01/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4050 E RUSSELL RD
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89120-3808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-884-4444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4454 N DECATUR BLVD
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89130-5286
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-340-1244
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR/OWNER
-----------------------------------------------------
Name | DR. DAVID LANZKOWSKY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 702-340-1244
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------