Basic Information
| Provider Information | |||||||||
| NPI: | 1013964824 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SRINIVAS VUTHOORI, MD, PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ODYSSEY MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 36670 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891336670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024078241 | ||||||||
| FaxNumber: | 7024921728 | ||||||||
| Practice Location | |||||||||
| Address1: | 2610 W HORIZON RIDGE PKWY | ||||||||
| Address2: | SUITE #103 | ||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890522869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024078241 | ||||||||
| FaxNumber: | 7024921728 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | VUTHOORI | ||||||||
| AuthorizedOfficialFirstName: | SRINIVAS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7024078241 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 10013 | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.