1194775403 NPI number — SPC CAPITAL LLC

Table of content: (NPI 1194775403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194775403 NPI number — SPC CAPITAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPC CAPITAL 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:
LAS VEGAS SPECIALTY SURGICAL CENTER
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:
1194775403
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1569 E FLAMINGO 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:
89119-5131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-633-0253
Provider Business Mailing Address Fax Number:
702-633-0334

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1569 E FLAMINGO 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:
89119-5131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-633-0253
Provider Business Practice Location Address Fax Number:
702-633-0334
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAWLEY
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
702-633-0253

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  4388ASC-0 , 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)





Copyright © 2007-2024 www.npivalidator.com