1437331014 NPI number — NEVADA SURGICAL SPECIALISTS LLC

Table of content: (NPI 1437331014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437331014 NPI number — NEVADA SURGICAL SPECIALISTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEVADA SURGICAL SPECIALISTS 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:
NEVADA SURGICAL SPECIALISTS, LLC
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:
1437331014
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3570 E FLAMINGO ROAD
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:
89121-5000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-454-3400
Provider Business Mailing Address Fax Number:
702-454-7185

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3570 E FLAMINGO ROAD
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:
89121-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-454-3400
Provider Business Practice Location Address Fax Number:
702-454-7185
Provider Enumeration Date:
12/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DENNY
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
702-254-3939

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  G2126 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 05906R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: NV5503 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0106X , with the licence number: 5503 , 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: 002002847 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01240039 . This is a "AMERIGROUP" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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