MEDICARE: VITUITY - NEVADA KOURY & PARTNERS 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
1	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1487255089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITUITY - NEVADA KOURY & PARTNERS PLLC

Provider Business Mailing Address
First Line	:	2100 POWELL ST STE 400
Second Line	:
City	:	EMERYVILLE
State	:	CA
Zip	:	94608-1826
Country	:	US
Telephone Number	:	510-851-7411
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 W CRAIG RD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0327
Country	:	US
Telephone Number	:	702-777-3615
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THEOPHILE G. KOURY
Credential	:
Telephone Number	:	510-851-7411

Provider Enumeration Date	:	11/02/2020
Last Update Date	:	12/21/2020

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