MEDICARE: EAST RUSSELL SURGERY PARTNERS LLC

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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1770476376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST RUSSELL SURGERY PARTNERS LLC

Provider Business Mailing Address
First Line	:	4454 N DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-5286
Country	:	US
Telephone Number	:	702-340-1244
Fax Number	:

Provider Business Practice Location Address
First Line	:	4050 E RUSSELL RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3808
Country	:	US
Telephone Number	:	702-884-4444
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR/OWNER
Name	:	DR. DAVID LANZKOWSKY
Credential	:	MD
Telephone Number	:	702-340-1244

Provider Enumeration Date	:	06/02/2025
Last Update Date	:	01/26/2026

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