1003889395 NPI number — LAS VEGAS OPHTHALMOLOGY ASC LLC

Table of content: (NPI 1003889395)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003889395 NPI number — LAS VEGAS OPHTHALMOLOGY ASC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAS VEGAS OPHTHALMOLOGY ASC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AMERICAN SURGERY CENTERS OF LAS VEGAS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003889395
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2575 LINDELL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89146-5409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-367-7874
Provider Business Mailing Address Fax Number:
702-227-6055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2575 LINDELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89146-5409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-367-7874
Provider Business Practice Location Address Fax Number:
702-227-6055
Provider Enumeration Date:
02/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PAYNE
Authorized Official First Name:
BILLIE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
615-665-1283

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  456ASC-10 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004602003 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 777021 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".